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TRANSACTIONS

OF THE

MEDICAL SOCIETY

OF THE
STATE OF NORTH CAROLINA.

FIFTY-FIFTH ANNUAL MEETING

HELD AT

Winston-Salem, N. C, June 16, 17 and 18, 1908.

President, Dr. J. HOWELL WAY, Waynesville, N. C.
Secretary, Dr. DAVID A. STANTON, High Point. N. C.

RALEIGH
EDWARDS & BROUGHToN PRINTING COMPANY

1908

Publication Committee.

Dr. D. a. Stanton High Point

Di{. E. C. Register Charlotte

Dk. VV. H. Wakefield Charlotte

"It is to te understood that the Society is not to be considered as en-
dorsing all the views and opinions of authors of papers published in the
transactions of the Society." — Extract from By-Laws, chap. 10, sec. 8.

CONTENTS

PAGE.

Dr. Joseph Howell Way Fiontispiece

Publication Committee 2

Historical Roslei-, Officers of Society, Meetings, Members Enrolled,

Attendance, etc., 1849 to 1908 G-8

Historical Roster, Members State Board of Medical Examiners from

1859 to 1908 9

Historical Roster, Members State Board of Health, 1877 to 1908.. 10
Officers of State Medical Society, Committees etc., Session at

Winston-Salem, June, 1908 U

Officers of State Medical Society, Session at Asheville, June, 1909, 12

Chairman of Sections, 1909 Session 13

Programme of Winston-Salem Se-sion, June, 1908 14-20

Minutes of Proceedings, Session 1908, General Meeting (See Inde.x

for Special Topics) 21-38

Minutes of Proceedings, Session Winston-Salem, 1908 50-174

House of Delegates (See Index for Special Topics) 175-195

State Board of Medical Examiners, Session, '1908 190-207

Synopsis of State Law and Rules Relating to Licensure 208-211

State Board of Health, Annual Session, 1908 214

Annual Report Secretary State Society, D. A. Stanton, M.D 178

Annual Report Secretary State Board of Health, R. H. Lewis, M.D. 215
Annual Report Treasurer State Society, H. McKee Tucker, M.D... 182
Invocation at Opening of Winston-Salem Session, Rev. H. A. Brovvn. 39

Address of Welcome at Opening Session, Hon. 0. B. Eaton 40

Response to Address of Welcoiue. C. L. Pridgeon, M.D 47

Discussions (see Index for Special subeets).

State Board of Medical Examiners, Election of 95

Proceedings of the State Society for the Prevention of Tuberculosis,

212-213

The Social Side of the Winston-Salem Meeting 106

The Council, Special Sessions of, at Winston-Salem Meeting. .. 121, 140
The Annual Report of Obituary Committee, C. A. Julian, M.D., 208-250
The President's Annual Address, "Random Notes on the History,

Aims and Purposes of tlie Medical Society of the State of North

Carolina," J. Howell Way, M.D 251-277

The Annual Oration, "The Physician and Education," Chas. S.

Mangum, M.D 278-283

The Annual Essav, "Lines of Progress in the Practice of Medicine,"

Thos. R. Little, M.D 284-294

"The Importance of the Work of the General Practitioner," Lewis B.

McBraver, M.D 295

Pellagra, Etiology and Pathology, C. H. Lavinder, M.D 303

"The Relation of the General Practitioner to Gynecology," J. Ernest

Stokes, M.D .' . 315

"The Medical Influence of the Negro in Connection wifh Anicmia

in the White Race," Chas. Wardell Stiles, M.D.. Ph.D 325

"Our Milk-Supplv and some of its Relations to Public Health,"

Tait Butler, D. V.S 335

"The Pelation of the Laboratory to the ureneial Practitioner,"

Watson S. Rankin, M.D 348

"Obstetric Work from the Standpoint of the General Practitioner,"

A. B. Croom, M.D 353

"The Pelation of the Ophthnlmolooist to the General Practitioner,"

Gnillfird S. Tennant. M.D.. . . .^ 350

"An Opinion as to th^ Ultimate Results Obtained from Surgical,

in Comparison with Medical Treatment in Certain Ovarjui

Diseases and in all Ovarian Xeuro=es," J. Allison Hod2;es, AID. 303
"The General Practitioner as a Surgeon," Edmund Harrison, M.D. . 370

4 COKTENTS.

PAGE.
"The Relation of the Surgeon to the General Practitioner," Thos.

E. W. Brown, M.D 374

"Some Observations on Pellagra in this Country with Special Ref-
erence to Insanity," John McCampbell, M.D 377

"Pellegra," Edward Jenner Wood, M.D 384

"Vaccine, or Tuberculin Therapy," H. B. Weaver, M.D 395

"Some of the Essentials in the Treatment of Moderately Advanced

Tuberculosis," J. E. Brooks, M.D 403

"The Diagnosis of Acute Miliary Tuberculosis," Silvio Von Ruck,

M.D 40G

"Use and Abuse of Drugs in Tuberculosis," W. M. Jones Jr., M.D . . 425
"Outdoor Life for the Prevention and Cure of Disease," Paul

Paquin, M.D 431

"The Importance of Early Diagnosis in Successful Treatment of

Tubercular AtTeetion," Daniel A. Dees, M.D 436

"A Report of Cases Treated with Ichthyolated Emulsion Compound,"

John R. Williams, M.D 439

"The Turn of the Tide of Tuberculosis Mortality," Martin L.

Stevens, M.D 444

"Tuberculin Therapy," C. S. Grayson, M.D 446

"Earlv Tuberculosis and Malaria, Their Differentiation," Paul H.

Ringer, M.D 452

"Some Atypical Manifestations of Malaria," J. W. P. Smithwick,

M.D 456

"The Treatment of Typhoid Fever," T. C. Quickel, M.D 462

"Milk-Sick, and Milk-Sickness," J. A. Reagan, M.D 467

"The Necessity of Quarantine in Pneumonia," C. B. Wilkerson, M.D., 471
"The Examiner's Golden Rules for Life Insurance Work," Albert

Anderson, M.D 477

"Reciprocity," A. A. Kent, M.D 481

"Surgical Conscience," John C. Rodman, M.D 487

"The Influence of the General Condition of Patient on the Result

of a Surgical Operation," Stuart McGuire, M.D 491

"A Plea for Early Operation in Appendicitis where the Diagnosis

is Obscure," J. F. Highsmith, M.D 504

"A Few Recent Unique Surgical Cases." Joseph Graham, M.D 511

"Some Practical Points in the Management of Inguinal Hernia,"

R. L. Payne, M.D 519

"Hydrocele." E. G. Moore, M.D 528

"Conservatism in Railway Surgery," W. P. Whittington, M.D 531

"Report of a Case of Tvphoid Cholecystitis, Operation, Recovery,"

Wm. A. Graham, M.D 534

"Appendicostomy in Amoebic Dysentery," Brodie C. Nalle, M.D. ... 537

"Local Anesthetics in Surgery," John A. Williams, M.D 540

"Some Points in Minor Surgery," W. J. McAnally, M.D 546

"Carbuncle," Thomas Eli Anderson, M.D 548

"Chrondromata, and Report of a Case Undergoing Malignant De-
generation," Eugene B. Glenn, M.D 552

"Ligation of the Femoral Artery, Results," J. R. Paddison, M.D... 556

"Endoaneurismorrhaphv," Thomas M. Green, M.D 560

"Abscess of the Brain," R. G. Buckner, M.D 567

"Prostatic Deafness," W. Perry Reeves, M.D 584

"The Importance of the Early Diagnosis and Treatment of the

Mastoid Complication of Middle Ear Disease," J. M. Lilly, M.D., 594

"An Interesting Case of Gangrene," K. P. B. Bonner, M.D 597

"An Interesting Case of Stone in the Bladder." J. M. Parrott, M.D. 603

"Influenzal Arthritis," James J. Phillips, M.D 608

"Empyema: Etiology, Symptoms, Treatment and When to Do Tho-
racotomy, with Report of Cases," John T. Burrus, M.D 614

"Management of the Third Stage of Labor," B. R. Graham, M.D... 620
"The Things That Kill Women in Child-Bearing, and How and

Why,"' H. D. Stewart, M.D 624

CONTENTS. 5

PAGE.

"A Monstrosity," J. W. Neal, M.D 632

"Some Obstetrical Monstrosities in Country Practice," G. L. Sykes,

M.D 634

"History of a Case of Hydatiform Mole," J. M. Williams, M.D 645

"Hydatiform Mole (Myxoma Chorii), with Report of Case," J. B.

Cranmer, M.D 647

"Puerperal Eclampsia," E. F. Strickland, M.D 651

"Puerperal Eclampsia: With Report of Cases," Jno. A. Ferrell, M.D. 65G

"Placenta Prsevia: Etiology and Treatment," H. B. Hiatt, M.D 661

"Excision of the Coccyx (Coccygectomy ) ," John R. Irwin, M.D.... 668

"Hysterectomy: Report of a Case," R. 0. Dees, M.D 672

"Diagnosis and Treatment of Ectopic Gestation from the Standpoint
of a Country Physician, with Report of a Case," G. F. Duncan,

M.D 677

"Maternal Nursing," Wm. W. McKenzie, M.D 686

"An Artificial Food Suitable for Young Infants," Charles Roberson,

M.D 692

"Scarlatiniform Eruptions," J. Stevens Brown, M.D 698

"Ileo-Colitis," H. L. Monk, M.D 700

"Pneumonia in Children," J. A. Turner, M.D 705

"Pleurisy in Children," J. R. McCracken, M.D 710

"Pseudo-Leucocythemia Infantum: Report of a Case," Jas. A. Tur-
ner, M.D., and Wm. M. Jones, Jr., M.D 717

"Coxa Vara," Wm. Moncure, M.D 720

"Artificial Interruption of the Physiological Circulation as a The-

repeutic Measure," E. T. Dicken-;on, M.D 725

"Diptheria, and a Word for Antitoxin," E. W. Hutchins, M.D. . . . 729
"The Importance of a Thorough Knowledge of Biology, Bacteri3logy,
and the Circulation of the Blood for the Successful Applica-
tion of Seriim Therapy," J. C. Grady, M.D 735

"Normal Salt Solution: Its Uses and Methods of Administration,"

C. A. Woodard. M.D 743

"Venesection, Its Indications and Uses as a Therapeutic Agent,"

W. M. Lyday, M.D 751

"Therapeutics an Art," W. H. Boone, M.D 757

"Hydrastis Treatment of Bright's Disease," Francis Duffy, M.D... 763
"A Case of Myxcedema Closely Simulating Brignt's Disease ,With a
Note on the Treatment of Renal Albuminuria by the Admin-
istration of Hydrastis Canadensis," Richard N. Dufl'y, M.D.... 771
"Adrenalin Cliloride: Its Uses in Medicine," C. 0. Abernethy, M.D., 776
"Toxic Changes from Prolonged Use of Acetanilid," H. H. Kapp,

M.D 780

"Morphine and Kindred Drugs: Their Use and Abuse," D. A. Bes-
semer, M.D 786

"Early Recognition and Treatment of Toxic Amblyopia, as Caused

by the Abuse of Alcohol and Tobacco," J. H. Honnett, M.D 789

"A Brief Report of Some Cases Which Have Yielded Surprisingly
to Electricity, to X-ray Treatment, Snow's Tubes and Mechani-
cal Vibration," J. Thoinas Wright, M.D 792

Constitution and By-Laws, Medical Society of North Carolina 799

Principles of Medical Ethics 815

Constitution and By-Laws for County Medical Societies 823

Members of the Medical Society of North Carolina, Alphabetical

List of 831

Members Component County Medical Societies of North Carolina.. 843

Honorary Members 895

Honorary Fellows 895

Appendix — A List of Physicians Licensed by the Board of Medical
Examiners of the State of North Carolina from Its Organiza-
tion in 1859 to 1908. Compiled from the Original Records by

a Former Secretary 896

Index 943

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ROSTER OF MEMBERS NORTH CAROLINA STATE BOARD OF HEALTH, FROM
ORGANIZATION IN 1877 TO 1908.

Name.

Address.

Appointed by

Term.

S. S Satchvvell.M. D., President

1 honi s F. Wood, M. D. .Secretary

•Toseph (irahum, M. D

Cliaik'S linttV,Jr.,M.D

I'cter K.Hiiic's. M. D

Georfe'e A. Foote. M. D

S. S. satchwell. M. D.. President

Thoniiis F. Wood, M. D., secretary

Chas. J. I j'llasan M. D., President

Geortre A. Foote. M. I)

Marcellns Wliitt-lie id, M. D

R. L. I'Hvno. M. D

H. <i. Wooilrin. M. D

A. R. I-('ilenx.Cliemist

Williiini Cain. Civil Engineer

R L layrie. M. I)

Ma'^ceiliis Whiteliefld, M. D., I'resident

J.M. I.yle, \I.D _..

Wiliiani ( ain. Civil Engineer

W.G.Simmons. Chemisi

J. >V. .Jones. ,M. I).. I'resident

John McL)onaM.M,D

S II.LvIm. M D

W. G. Simmons. Cliemi.st

Artlinr Winslow, Civil Engineer

R 11. Lewis. \r. n .

Thomas F. Wood, M. D., Secretary

William D. IliiliMni.M. U

Artlinr Winslow. Civil Engineer

W. G. Simmons. Chemist

J.H.Tnclcer.M. 1)

R. It. Lewi>, M. I >., Secretarv

H T. Bahnson. M. D , President

Arthur Win~Iow. Civil Engineer

W. G. Simmons, Chemist

J. H. TncUer. M. D

J. L. Lndlow, ( ivil Enijineer

J H.T.icker. M. D

F. P. Venable, fh. D., Chemist

J. L. Ludlow, I ivil Engineer

J. A.Uodge.s. M.D

J. M. Hak-r, .M D

J. H. Tncker, .\1. D

F. r. Venrtbie. I'h. D.. chemist

J L. Lnillow, Civil Engineer

* Thomas K. Wood, M. 1)., Secretary -_.

George G. Thomas, M. I)., President

S. Uesirav Haitle. M. D

W. H. Harrell, M. D

John Whitehead, M.D

W. H.G. I.nea.s, M.D

F. P. Venable, I'h. D.. Chemi-t

John C. Chase. Civil Engineer

R. H. Lewis, M. D , Secretary

W. P. Beall, M. D

John \Vhiteheai,M. D

W. H. Harrell, M. D -_„

W. P. HeM.ll, M. D

W. .1 . Lum>den, M. D

R.H. Lewis, M. I)., secretary

F. P. Venable, Ph. D.. Chemist

John C. Chase. Civil Engineer

C.J.O'tiHgHn. M. D

John D. Si.icer. M. D

J L. Nicholson, M,D

R. H. Lewis, M. D.. Secretary

A. W. Shaffer. Sanitarv En>;ineer

Charles J. O'Hagaii. M. D

J. L. Nicholson, M. D

Albert Anderson, M. D

R. H. Lewis, M. D.. Secretary

A. W.Shaifcr. Civil Engineer

(ieorge G. Thomas. M. D., President _-

S. Westrav Battle, M. D

H. W. Lewi.s. M. D

H. H. Uod^on. M. D

R. H. Lewis. M. D., Secretary

W. P. Ivey, M. D

George <t. Thomas, M. D., President ..

Francis Duffy. M I >

J. L Lndliiw, Civil Kngineer

S. WesirHv Battle, M.D

H. W. Levvis. M.D

W. H. Whitehead. M. D

J. L. Nichol-on.M. D

J. L. Ludlow, Civil Engineer

J.Howell Way. M.D_.

W. C. Spencer. M. D

George G. Thomas, M. D., President-..

Thomas E Anderson, M.D

R. H. Lewis, M. D

E. (;. Register, M. D

David T. Tayloe, M. D

James A. Burroughs, M. D

Rocky Point

Wilniins;ion

ciiarloite

New Bern

Raleigh

Warrenton

Rocky Point

VNilmington

Greenville

Warrenton

.Salisbury

Lexington

I'ranklin

Chapel Hill

Charlotle

Lexington

.sallsl)iiry

Franklin

Charlotte

Wake i-orest

Wake Forest

Washington

I'^ranklin

Wake l-'orest

Raleigh

Wilmington

Asheville

Raleigh

Wake Forest

Henderson

Raleigh

Winston-Salem_.

Raleigh

AVake Forest

Henderson

Winston

llemlerson

ChRpel Hill

Winston

Kayetieville

Tarboro

Henderson

Chapel HiJl

Will-ton

Wilmington

A-heville

Williamston

Salisbiirv

White Hall

Chapel Hill

V\ ilmington

Ralei.yh

Greensboro

Salisbury

Williamston

Greensboro

p:iizabeth City

Raleigh

Chapel Hill

Wilmington

Greenville

(ioldsboro

Kichlands

Raleigh

(Jreenville

Richlands

Wilson

Ralei.tfh

Raleigh

Wilmington _—

Asheville

Jackson

Milton

Raleii;h

Lenoir

Wilminiiton

New Bern

Winston

Asheville

Northampton _

Rocky Mount

Kichlands

Winston

VN'avnesvil e..

Win-ton

\\ ilmiii.gtoD..

Statesville

Raleigh

Charloite

Washington.-
Asheville

State Society

Si te Societv

state Society

State Society

state Socieiy

State *oi!iety

state Society

State Society

Slate Socieiy

State Society

State society

Gov. Z. B. Vance

' ■ov. Z. B. Vance

Gov. Z. B. Vance

State Society

Suite Society

(iov T.J.Jarvis

Gov. T.J. Jarvis

Gov.T. .1 Jarvis

stale Society

S ate Society

Gov.T. .1. Jarvis

• Jov. T. J Jarvis

Gov. T. J. Jarvis

State BoHrd

State So iety

state Society

Gov. A. M. .-'(•ales

(tOV. a. M. Scirtles

(iov A.M. Scales

State Society

State Societ.v

Gov. A. M. Scales

(^ov.A. M Scales

Gov. A. M. Scales

liov. D. (i. Fowle

(iov. D. (L Fowle

(fov. I>.G. lowle

State Society

Slate Siiclety

Gov. 'I'homas M. Holt.,
(iov. ThoniMS M. Holt__.
(4ov. Thomas INI. Holt..

State Society

State Board Health

State Society

Slate Society

State BOHrd Health

Cov. Flias Carr

Gov. K.lias Carr

Gov. E'ias Carr

Gov EliHS Carr

Gov. Klias Carr

State Society

StHte Society

Gov. Elias Carr

Gov. F.llas ("arr

(lov. Ellas Carr

Gov. Elias Carr

Cov. Elias CaiT

(iov D. L. Ru-ssell

Gov. D. L. Russell

Gov. D L. Russell

(iov. D.L. Rus.sell

Gov. D. L Russell

Gov. D.L. Rns-ell

Gov. D. L. Russell

Gov. D. L.Russell

Gov. D. L. Kns.sell

(iov. D. L. Russell

state Societv

St>ite Society

Slate Society

State Society

Gov. C B. Aycock

Gov.C B. Aycock

(iov. C. B. Avcock

Gov C. B. Ai cock

Gov. C. B. Aycock

SfHte Society

Slate Society

Stiite Socieiy

State Society

Gov.C B. Avcock

(iov. R.B. Glenn..
Gov R. ii Glenn-
State Society

State Society

(iov. R.B.Glenn..
Gov.R. R. (ilenu-.

State Society

lh77 to 1^78
i877 to 1878
1877 to I.S78
1.^77 to 1878

1877 to 1S78

1577 to 1878

1878 to lN8-t
lh78 to 1884
1878 to 1.S82
1,S7.S to 1882
1S7S to 1880
1878 to 1880
lh78 to 1^80
1878 10 1880

1578 10 In8I>
1881 to 1887
I8SI to 1884
1881 to I.S8:{
ISM to 1883
1881 to 1883
IMSH to 1889
I88S to 1889
18S8 to 1885
i88:f to 1S8.5
IhSUo 1886
I,S8-1 to 1893
188.T to 1887
I8h5 10 l.s9l
I88n to !8!)L
1S8.') to 1887
18sr, to |,SK7
IS87 to 18117
Is87 to 1893
1 887 to 1888

1887 lo 889
18S7 to 18S9

1888 to 1S91
I8S<I to 1891
1S.S9 to 18!) I

1889 to :8!)3
I8S!I to 1«92
ISM) to I8!)3
I Sill to 1893
1S9I to 1893

1891 to 1892
18111 to 1S97

1892 to 1897

1891 to IS9>

1892 10 1811.5
IMli to 1S95
I8'.« to 1895
ISO'- to 1895
IS9:i to 1895
189.S to 1S95
ISM to 1S97
189-") to 1897
ls9o to 1S97
1895 to 1897
18!i5 to 1897
1895 10 1897
18ii5 to 1897
189.") to IS97
1897 to 1S99
18VI7 to 1899
1S97 lo 1S99
1,897 to 1S99
1897 10 1899
1899 to 190L
1899 to 1901
1899 to 1901
1S99 to 1901
1,S99 to 1901
18911 to 1901
1899 to 1901
1899 10 1901
IS99 to 1901
1901 to 1907
1901 to 1997
1901 to 1905
1901 to 1905
1901 to 1903
1901 to 1907
19l)i to 1907
1901 to 1905
'.901 to 1905
1903 to 1909
190."i to I91L
1905 to 1911
1905 to 1911
1905 to 1911
1907 to 1913
1907 to 1913
1907 to 1913
1907 to 1913

* Died iu 1892, leaving a five-year unexpired term, which was filled by the Board.

Officers and Committees, 1908.

Meeting at Winston-Salem, N. C.

President— Dr. J. HOWELL WAY Waynesville.

First Vice-President— Dr. J. E. STOKES Salisbury.

Second Vice-Presdient— Dr. J. A. TURNER High Point.

Third Vice-President— Dr. NIXON EDWARDS Beaufort.

•fSecretary— Dr. DAVID A. STANTON High Point.

"i Treasurer— Dr. H. McKEE TUCKER Raleigh.

Councilors.*

First District — Dr. Oscar i\Ie^Iullen, Elizabeth City.

Second District — Dr. R. A. Whitaker, Kinston.

Third District — Dr. Frank H. Russell, Wilmington.

Fourth District — Dr. Albert Anderson, Wilson.

Fifth District— Dr. J. F. Highsmith, Fayetteville.

Sixth District — Dr. Hubert A. Royster, Raleigh.

Seventh District — Dr. Chas. M. Strong, Charlotte.

Eighth District — Dr. J. B. Smith, Pilot Mountain.

Ninth District — Dr. Isaac M. Taylor, Morganton.

Tenth District — Dr. Jas. A. Burroughs, Asheville.

Orator — Dr. Chas. S. Mangum, Chapel Hill.

Essayist — Dr. Thos. R. Little, Greensboro.

Leader of Debate — Dr. S. E. Koonce, Wilmington.

ZMemhers House of Delegates American Medical Association — Dr. J.
F. Highsmith, Fayetteville; Alternate, Dr. Joseph Ackerman, Wil-
mington; Dr. A. J. Ciowell, Charlotte; Alternate, Dr. E. Reid Rus-
sell, Charlotte; Dr. Pride J. Thomas, Wilmington; Alternate, Dr.
Albert Anderson, Raleigh.

Committee on Public Policy and Legislation — Dr. J. Howell Way,
Waynesville; (ex officio) Dr. R. H. Lewis, Raleigh; Dr. H. A. Roys-
ter, Raleigh; Dr. J. E. Brooks, Greensboro; Dr. D. A. Stanton, High
Point, [ex officio).

Committee on Publication — Dr. E. C. Register Charlotte; Dr. W.
H. Wakefield, Charlotte; Dr. D. A. Stanton, High Point, (ex officio).

Committee on Finance — Dr. R. W. Smith, Hertford; Dr. W. A.
Monroe, Monroe; Dr. D. A. Garrison, Bessemer City.

Committee on Scientific Work — Dr. E. J. Wood, Wilmington; Dr.
John C. Rodman, Washington; Dr. D. A. Stanton, High Point, (ex
officio.)

Committee on Obituaries — Dr. Chas. A. Julian, Thomasville; Dr.
Benj. K. Hays, O.xford; Dr. R. L. Gibbon, Charlotte.

Local Member Committee on Arrangements, Winston-Salem Session,
1908— Dr. W. O. Spencer, Winston-Salem.

* Councillors elpcted for three years, terms expiring at 1910 session,
t Terms expire at I9(ii) ses-ion.
I Terms expired at 1908 session.

Officers and Committees, 1909.

President— Bn. J. F. HIGHSMITH Fayetteville.

First Vice-President— Dr. C. M. POOLE Salisbury, R. F. D.

Second Vice-President — Dr. D. A. GARRISON Bessemer City.

Third Vice-President — Dr. D. A. DEES Bayboro.

Secretarij—Dn. D. A. STANTON, (Term expires 1909) High Point.

Treasurer— Dr. H. McKEE TUCKER (Term expires 1909) .. .Raleigh.

Councilors.

(Term expires 1910.)

First District — Dr. Oscar McMullan, Elizabeth City.

Second District — Dr. R. A. Whitaker, Kinston.

Third District — Dr. Frank H. Russell, Wilmington.

Fourth District — Dr. E. T. Dickinson, Wilson.

Fifth District— Dr. J. F. Highsmith, Fayetteville.

Sixth District— Dr. Hubert A. Royster, Raleigh.

Seventh District — Dr. Chas. M. Strong, Charlotte.

Eighth District — Dr. J. B. Smith, Pilot Mountain.

Ni7ith District — Dr. Isaac M. Taylor, Morganton.

Tenth District — Dr. James A. Burroughs, Asheville.

Orator — Dr. Chas. W. Moseley, Greensboro.

Essayist — Dr. Wm. LeRoy Dunn, Asheville.

Leader of Debate — Dr. Leon B. Newell, Charlotte.

Members House of Delegates American Medical Association — Dr. J.
Howell Way, Waynesville; Alternate, Dr. P. J. Thomas, Wilmington
(1908-1910) ; Dr. A. J. Crowell, Charlotte; Alternate, Dr. D. S. George,
Bayboro, (1908-1910); Dr. D. A. Stanton, High Point; Alternate, Dr.
H. H. Dodson, Greensboro, (1908-1909).

Committee on Public Policy and Legislation — Dr. J. F. Highsmith,
Fayetteville; ex officio; Dr. R. H. Lewis, Raleigh; Dr. Geo. G.
Thomas, Wilmington; Dr. Albert Anderson, Raleigh; Dr. D. A. Stan-
ton, High Point, ex officio.

Committee on Publication — Dr. E. C. Register, Charlotte; Dr. W.
H. Wakefield, Charlotte; Dr. D. A. Stanton, High Point, ex officio.

Committee on Scientific Wor-k — Dr. Watson S. Rankin, Wake Forest;
Dr. John Bynum, Winston; Dr. D. A. Stanton, High Point, ex officio.

Committee on Finance — Dr. H. S. Lott, Winston-Salem; Dr. J. M.
Blair, Monroe; Dr. R. E. L. Flippen, Pilot Mountain.

Committee on Obituaries — Dr. Chas. A. Julian, Thomasville; Dr. A.
A. Kent, Lenoir; Dr. S. T. Nicholson, Washington.

Committee on Arrangements Asheville Session 1909, Local Member of
—Dr. Thos. E. W. Brown, Asheville.

The fifty-sixth annual .session of the Medical Society of tlie State of North Carolina
will convene at Abbeville, N. C. June 14. I90!i. The hearty cooperation nnd attendance
of all memhers of the component Connty Medical Societies of the State Is desired to
make the occasion the most complete success posible.

Chairmen of Sections

Session of 1909

Anatomy and Surgery — Dr. T. E. W. Brown, Asheville.
Materia Medica and Therapeutics — Dr. John Q. Myers, North
Wilkesboro.

Practice of Medicine — Dr. Edward Jenner Wood, Wilmington.
Physiology and Chemistry — Dr. L. B. Newell, Charlotte.
Obstetrics — Dr. A. B. Croom, Maxton.
G-ynecology — Dr. H. A. Eoyster, Ealeigh.

Medical Jurisprudence and State Medicine — Dr. W. P. Holt, Duke.
Pathology and Microscopy — Dr. Watson S. Rankin, Wake Forest.
Railway Surgery — Dr. J. Vance McGougan, Fayetteville.
Pwdiatrics — Dr. James J. Philips, Tarboro.

Delegates to Mississippi Valley Medical Association — Dr. W. 0. Spen-
cer, Winston-Salem; Dr. J. H. Shuford, Hickory; Dr. Cyrus Thompson,
Jacksonville; Dr. W. D. Pemberton, Concord; Dr. W. N. Hicks, Dur-
ham; Dr. W. J. Stevens, Ashpole.

Delegates to Virginia Medical Association — Dr. J. L. Doughton, Al-
leghany; Dr. J. J. Philips, Tarboro; Dr. S. C. Highway, Murphy; Dr.
F. H. Gilreath, North Wilkesboro; Dr. J. A. Williams, Greensboro.

Delegates to South Carolina State Medical Association — Dr. W. D.
Witherbee, Charlotte; Dr. D. N. Dalton, Winston-Salem; Dr. Earle
Grady, Tryon; Dr. J. F. McKay, Buie's Creek.

State Board of Medical Examiners, 1908-1914 — Dr. John C. Rodman,
Washington, President, Chemistry and Pediatrics; Dr. Benj. K.
Hays, Oxford, Secretary, Materia Medica; Dr. Lewis B. McBrayer,
Asheville, Surgery; Dr. Wm. W. McKenzie, Salisbury, Anatomy and
Histology; Dr. Henry H. Dodson, Greensboro, Practice of Medicine;
Dr. John Bynum, Winston-Salem, Obstetrics and Gynecology; Dr. J.
L. Nicholson, Richlands, Physiology and Hygiene. (Annual meating
Asheville, N. C, June 9, 1909.)

The North Carolina State Board of Health — Dr. Geo. G. Thomas,
President, Wilmington; Dr. Richard H. Lewis, Secretary-Treasurer,
Raleigh; Dr. J. Howell Way, Waynesville; Dr. Thos. E. Anderson,
Statesville; Dr. W. 0. Spencer, Winston-Salem; Dr. E. C. Register,
Charlotte; Dr. James A. Burroughs, Asheville; Dr. David T. Tayloe,
Washington; Col. J. L. Ludlow, Civ. Eng., Winston-Salem.

Council on Medical Education of A. M. A. — Dr. Chas. J. O'H. Laugh-
inghouse, Greenville; Dr. Kemp P. Battle, Jr., Raleigh; Dr. Chas. M.
Strong, Charlotte.

Member National Legislative Council, A. M. A. — Dr. J. Howell Way,
Waynesville.

Program of the Fifty-fifth Annual Meeting of the

Medical Society of the State of North

Carolina Held in Winston-Salem

June 16, 17 and 18, 1908.

OFFICERS SESSION 1908,

President— J. HOWELL WAY, M.D Waynesville.

First Vice-President— J. E. STOKES, M.D Salisbury.

Second Vice-President— J. A. TURNER, M.D High Point.

Third Vice-President— l^JXO'^ EDWARDS, M.D Beaufort.

Secretary— D. A. STANTON, M.D High Point.

Treasurer— H. McKEE TUCKER, M.D Raleigli.

Committee on Arrangements — W. 0. Spencer, Chairman; H. T. Bahn-
son, M.D., D. N. Dalton, M.D., J. L. Haines, M.D.

ENTERTAINMENT.

The ladies of Winston-Salem have arranged to give the Society a
street car ride over the city and a supper at the Park. Cars will
leave the Public Square at 5:30 p. m., Wednesday and after touring
the city will ariive at the Park about 7 p. m. After supper has been
served the Annual Oration and Essay will be delivered in the Pavilion.

ORDER OF EXERCISES.

Tuesday Mor.ning, June IGth, 10 A. M. to 1:30 P. M.

Call to order by Chairman, Dr. W. 0. Spencer.
Invocation by Rev. H. A. Brown, Winston.
Address of Welcome by Mayor 0. B. Eaton, Winston.
Response to Address of Welcome by Dr. C. L. Pridgen, Kinston.
"The Presidenfs Annual Address," Dr. J. Howell Way, President,
Waynesville.

Section on Anatomy and Surgery — Dr. Joshua Tayloe, Chairman,
Washington.

1. "Diagnostic Value of Explanatory Incision, with Case Cited," Dr.
Joshua Tayloe, Washington.

2. "Some Points on Minor Surgery," Dr. W. J. McAnally, High
Point.

3. "Ligation of the Femoral Artery Eight Hours After Injury —
Results," Dr. J. R. Paddison, Oak Ridge.

4. "Orthopedic Surgery," a Plea for the Crippled and Deformed
Childien of North Carolina, Dr. J. L. Haines, Winston.

5. "Some Practical Thoughts on Hernia," Dr. R. L. Payne,
Norfolk, Va.

PROGRAM FIFTY-FIFTH AXXUAL MEETIXG. 15

June 16th, 2:30 p. m.

House of Delegates called to order by the President in County Com-
missioners' Eoom.

G. "jNIesenteric Tlirombus Following Splenectomy," Dr. J. W. Long,
Greensboro.

7. "Excision of the Coccyx," Dr. John R. Irwin, Charlotte.

8. "The Surgical Conscience," Dr. John C. Rodman, Washington.

9. "Etiology, Symptoms, Diagnosis and Treatment of Empyema with
Report of Thoracotomy," Dr. J. T. Burrus, High Point.

10. "Hydrocele," Dr. E. C. Moore, Elm City.

11. "The General Practitioner as a Surgeon," Dr. Edmund Harrison,
Greensboro.

12. "Traumatic Aneurism, with Report of a Case," Dr. J. B. Gibbs,
Lexington.

13. "An Interesting Case of Gangrene," Dr. K. P. B. Bonner, More-
head City.

14. "Cancer as We View It To-day," Dr. W. 0. Spencer, Winston-
Salem.

15. "Coxa Vara," Dr. Wm. Moncure, Raleigh.

IG. "Conservative Surgery," Dr. Joseph Akerman, Wilmington.

17. "The Value of Anti-operative Tests," Dr. C. M. Strong, Charlotte.

18. "An Interesting Case of Stone in the Bladder," Dr. James M.
Parrott, Kinston.

19. "The Importance of Early Treatment of the Mastoid Complica-
tions of Middle Ear Disease," Dr. J. M. Lilly, Fajetteville.

20. "Abscess of the Brain," Dr. R. G. Buckner, Asheville.

21. "The Influence of the Constitutional Condition of the Patient
on the Result of the Operation," Dr. Stuart McGuiie, Richmond, Va.

22. "Carbuncle, its Etiology, Pathology and Treatment, Particularly
the Latter," Dr. T. E. Anderson, Statesville.

23. "Endo-Aneurismorrhaphy," (Matas) Dr. Thos. M. Green, Wil-
mington.

24. "Appendicostomy in Amoebic Dysentery, Report of Cure," Dr.
Brodie C. Nalle, Charlotte.

25. "Chondromata and Report of Case, Undergoing Malignant De-
generation," Dr. Eugene B. Glenn, Asheville.

Tuesday, June 10th, 8:30 P. M.

"Memorial Services," Dr. C. A. Julian, Chairman Obituary Com-
mittee.

2G. "In Memoriam, Patrick Livingston Murphy," Dr. R. H. Lewis,
Raleigh.

"In Memoriam, Patrick Livingston Murphy," by Dr. G. G. Thomas,
Wilmington.

27. "Life and Work of Dr. P. L. Murphy," by Dr. G. M. Cooper,
Clinton.

28. "A Tribute to Dr. Joseph Graham," Dr. H. T. Bahnson, Winston-
Salem.

16 PEOGRAM FIFTY-FIFTH ANNUAL MEETING.

Wednesday, June 17tli, 9 A. M.
Section on Practice — Dr. L. B. McBruyer, Chairman, Asheville.

29. "The Impoitaine of the Work of the General Practitioner," Dr.
L. B. McBrayer, Asheville.

30. "The Relation of the General Practitioner to Gynecology," Dr. J.
E. Stokes, Salisburj''.

31. "Obstetrical Work from the Standpoint of the General Practi-
tioner," Dr. A. B. Groom, Maxton.

32. "The Relation of the General Practitioner to Surgery," Dr. T. E.
W. Brown, Asheville.

33. "The Relation of the General Practitioner to the Ophthalmolo-
gist," Dr. Galliard S. Tennant, Asheville.

34. "Pain in the Abdomen and What It means to the General Prac-
titioner," Dr. Henry F. Long, Statesville.

35. "Manners in the Sick Room," Dr. C. S. Jordan, Asheville.

36. "The Results of Surgery, as Seen by the General Practitioner,
Not Being an Adverse Criticism," Dr. J. Allison Hodges, Honorary
Member, Richmond, Va.

Conjoined Session State Board of Health, Wednesday 12 O'clock.
Dr. Richard H. Leivis, Secretary, Raleigh.

37. "Soil Pollution, With Special Reference to Hook Worm Dis-
ease," Dr. Charles Wardell Stiles, Chief Dept. Zoology, Washing-
ton, D. C.

38. "Milk Supplies in Relation to Public Health," Dr. Tait Butler,
State Veterinarian, Raleigh.

Subsection on Pellagra — Dr. Edward J. Wood, Chairman, Wilmington.

39. "Pellagra, Its Nature, History and Appearance in This Coun-
try," Dr. Edward J. Wood, Wilmington.

40. "Pellagrous Insanity," Dr. John McCampbell, Morganton.

41. "Etiology and Pathology of Pellagra," Dr. C. L. Lavinder, U. S.
P. H. and M. H. S.

Suhsection on Tuberculosis in Collaboration luith the North Carolina

Association for the Prevention of Tuberculosis.

John Roy Williams, Chairman, Greensboro.

42. "Report of Cases Treated With Ichthyolated Emulsion Com-
pound," Dr. John Roy Williams, Greensboro.

43. "Vaccine or Tuberculin Therapy in the Treatment of Tubercu-
losis," Dr. H. B. Weaver, Asheville.

44. "TTie Importance of Early Diagnosis in the Successful Treat-
ment of Tubercular Affection," Dr. Daniel A. Dees, Bayboro.

45. "The Turn of the Tide of Tuberculosis Mortality," Dr. M. L.
Stevens, Asheville.

PEOGKAM FIFTY-FIFTH AXXUAL MEETIIS^G. 17

46. "Our Greatest Need in the Successful Treatment of Tubercu-
losis," Dr. E. L. Stamey, Greensboro.

47. "Tuberculin Therapy," Dr. C. S. Grayson, High Point.

48. "Early Tuberculosis and Malaria, Their Differentiation," Dr.
Paul H. Ringer, Asheville.

49. "The Importance of Regime in the Treatment of Tuberculosis,"
Dr. I. J. Archer, Black Mountain.

50. "Treatment of Incipient Tuberculosis," Dr. J. E. Brooks,
Greensboro.

51. "The Use and Abuse of Drugs in Tuberculosis," Dr. W. M.
Jones, High Point.

52. "Outdoor Life in the Treatment of Respiratory Troubles and
Some Other Matters," Dr. Paul Paquin, Asheville.

53. "A Few Suggestions for Those Suffering from Tuberculosis,"
Dr. Wm. R. Kirk, Hendersonville.

54. "Diagnosis of Acute Miliary Tuberculosis," Dr. Silvio von Ruck,
Asheville.

(At this point the North Carolina Association for the Prevention
of Tuberculosis requests the floor for about ten minutes for the pur-
pose of electing delegates to the National and International Associa-
tion, announcements, etc.)

Subsection on General Diseases and Miscellaneous Papers.
Dr. Chas. B. Wilkerson, Chairman, Apex.

55. "The Necessity of Quarantine in Pneumonia," Dr. Chas. \Yilker-
son, Apex.

56. "Childhood with Its Exacting Cares and Responsibilities and
Glorious Results," Dr. I. W. Faison Charlotte.

57. "Influenza," Dr. J. H. Merritt, Woodsdale.

58. "Acute Rheumatism," Dr. L. B. Young, Robbinsville.

59. "Report of a Case of Typhoid Cholecystitis," Dr. W. A. Gra-
ham, Durham.

60. "Venesection, its Indications and Uses as a Tlierapeutic Agent,"
Dr. Wm, Moncure Lyday, Penrose.

61. "Milk Sickness," Dr. J. A. Reagan, Weaversville.

62. "A Practical Study of Epilepsy," Dr. E. S. Warlick, Morganton.

63. "The Examiner's Golden Rules for Life Insurance Work," Dr.
Albert Anderson, Raleigh.

64. "Reciprocity Between the State Examining Boards," Dr. A. A.
Kent, Lenoir.

65. "The Role of Moral Trauma in Producing Physical Damage,"
Dr. R. S. Carroll, Asheville.

66. "Brights Disease, Hydrastis Treatment of," Dr. Francis Duffy,.
New Bern.

67. "A More Liberal Use of Hydrastis in Kidney Troubles," Dr. R.
A. Whitaker, Kinston.

18 PEOGRAM FIFTY-FIFTH A]Sr]SrUAL MEETING.

68. "Some Atypical Forms of Malaria," Dr. J. W. P. Smithwick,
LaGrange.

69. "Treatment of Typhoid Fever," Dr. T. C. Quickel, Stanley.

70. "Epidemic of Malignant Cholera as Observed in the Philippine
Islands," Dr. C. G. Bryant, Spruce Pine.

71. "Application of Dietetics in Acute and Chronic Intestinal Infec-
tions," Dr. Fenton B. Turck, Chicago, 111.

72. "A New Method of Shortening an Ocular Muscle with Exhiln-
tion of Instruments," Dr. H. H. Briggs, Asheville.

73. "Early Recognition and Treatment of Toxic Amblyopia as
Caused by the Abuse of Tobacco and Alcohol," Dr. Harry Honnett,
Wilmington.

74. "Influenzal Arthritis," Dr. Jas. J. Philips, Tarboro.

75. "Perforation and Peritonitis Complicating Typhoid Fever," Dr.
Edwin C. Register, Charlotte.

76. "Personal Views on the Treatment of Typhoid Fever," Dr. C.
E. Reitzel, High Point.

77. "Aerostatic Deafness, its Etiology and Treatment," Dr. W. P.
Reaves, Greensboro.

78. "To Be Rather Than Seem," Dr. N. C. Hunter, Rockingham.

79. "Report of a Cure — A Remarkable Case of J^'ever in a Pregnant
Woman," Dr. Cyrus Thompson. Jacksonville.

Wednesday Evexixg, Jime 17th, 8:30.
(To which the public is invited.)

80. The Annual Oration: "The Physician and Education," Dr. Charles
S. Mangum, Chapel Hill.

81. The Annual Essay: "The Lines of Progress in the Practice of
Medicine," Dr. Thomas R. Little, Greensboro.

Section on Materia Meclica and Therapeutics — Dr. L. N. Glenn,
Chairman, McAdensville.

82. "The Rational Trend of Modern Therapeutics," Dr. L. N. Glenn,
McAdensville.

83. "Cathartics," Dr. M. A. Royall, Yadkinville.

84. "The Importance of Proper Dosage in the Administration of
Quinine," Dr. Parran Jarboe, Greensboro.

85. "Normal Salt Solution, Its Use and Method of Administration,""
Dr. C. A. Woodard, Durham.

86. "A Brief Report of Some Cases Which Have Yielded Surpris-
ingly to X-Ray Treatment Aided by Snow's Tubes and Mechanical "Vibra-
tion," Dr. J. Thomas Wright, Winston-Salem.

87. "Anesthetics," Dr. Southgate Leigh, Norfolk, Va.

88. "Adrenalin Chloride, Its Use in Medicine," Dr. C. 0. Abernethy,
Raleigh.

89. "The Use and Abuse of Morphine and Kindred Drugs," Dr. D. A.
Garrison, Bessemer City.

PKOGEAM FIFTY-FIFTH ANXUAL, MEETIISTG. 19

90. "Therapeutics an Art," Dr. W. H. Boone, Morrisville.

91. "A Plea for Fewer and Simpler Remedies," Dr. John Hill Tucker,
Henderson.

Section on Gynecology and Ahdomhial Surgery — Dr. J. F. Highsmith,
Chairman, Fayetteville.

92. "A Plea for Early Operation in Appendicitis When the Diagnosis
is Obscure," Dr. J. F. Highsmith, Fayetteville.

93. "Hysterectomy With Eeport of a Case,"' Dr. Rigdon 0. Dees,
Greensboro.

94. "Surgery of the Stomach," Dr. W. F. Faison, Jersey City, X. J.

95. "Imperforate Hymen with Report of a Case," Dr. S. C. Highway,
Murphy.

96. "Diagnosis and Treatment of Ectopic Gestation from the Stand-
point of a Country Doctor, with Report of Case," Dr. G. F. Duncan,
High Point.

Section on Obstetrics — Dr. Chas. T. Harper, Chairman, Wilmington.

97. "The Management of Pregnancy," Dr. Charles T. Harper, Chair-
man, Wilmington, N. C.

98. "Demand for Early Surgical Interference in Pernicious Vomit-
ing of Pregnancy," Dr. J. A. Williams, Greensboro.

99. "Placenta Proesia," Dr. H. B. Hiatt, Clinton.

100. "Chloroform in Labor," Dr. J. Steven Brown, Hendersonville.

101. "Eclampsia," Dr. John A. Ferrell, Kenansville.

102. "Tubal Pregnancy," Dr. Owen Smith, Asheville.

103. "Puerperal Eclampsia," Dr. C. M. Pool, Salisbury.

104. "Puerperal Eclampsia," Dr. E. F. Strickland, Bethania.

105. "Some Obstetrical Monstrosities in a Country Practice," Dr.
Gibson L. Sykes, Salemburg.

106. "Management of Freak Presentations," Dr. W. F. Mitchell, Shelby.

107. "The Things That Kill Women in Childbearing, and How and
Why," Dr. H. Stewart, Monroe.

108. "Management of Labor," Dr. J. W. McGehee, Reidsville.

109. "Hydatidiform Mole, with Report of a Case," Dr. J. B. Cran-
mer, Wilmington.

110. "Csesarean Section with Rejiort of Cases," Dr. H. McKee Tucker,
Raleigh.

111. "History of Cure of Hydatidiform Mole," Dr. J. M. Williams,
Warsaw.

112. "The Management of the Third Stage of Labor," Dr. B. E.
Graham, Wallace.

Section on Pcediatrics — Dr. W. W. McKenzie, Chairman, Salishury.

113. "Maternal Nursing," Dr. W. W. McKenzie, Salisbury.

114. "An Artificial Food Suitable for Young Infants," Dr. Chas.
Roberson, Greensboro.

20 PEOGEAM FIFTY-FIFTH A^N'NUAL, MEETING.

115. "Scarlatiniform Eruption," Dr. J. S. Brown, Hendersonville.

116. "Pneumonia in Children," Dr. J. A. Turner, Hight Point.

117. "Iliocolitis," Dr. H. L. Mock, Spencer.

118. "Diphtheria and a Word for Antitoxin," Dr. E. M. Hutchens,
Boonville.

119. "Adenoids in Children, Etiology, Symptoms and Sequelae," Dr.
J. B. Wright, Lincolnton.

120. "Post-scarlatinal Nephritis," Dr. W. J. Meadows, Greensboro.

121. "Acute Gastro-intestinal Intoxication W^ithout Diarrhoea in
Children," Dr. S. A. Wilkins, Gastonia.

122. "Pleurisy in Children," Dr. J. E. McCracken, Waynesville.

123. "Clinical Report of a Case of Pseudo-leucocythemia Infantum,"
Dr. W. M. Jones, High Point.

Section on Physiology and Chemistry — Dr. E. T. Diclcinson,
Chairman, ^Vilson.

124. "Artificial Interruption of the Physiological Circulation as a
Therapeutic Measure," Dr. E. T. Dickinson, Wilson.

125. "The Physiology of the Kidney and the Essential Examination
of the Urine," Dr. I. W. Lamm, Lucama.

126. "The Importance of a Thorough Knowledge of Biology, Bacteri-
ology and of the Circulation of the Blood for the Successful Application
of Serum Therapy," Dr. J. C. Grady, Kenly.

127. "The Necessity of Chemical Examination of the Stomach Con-
tents in Gastro-intestinal Diseases," Dr. C. W. Moseley, Greensboro.

128. "The Relation of the Laboratory to the General Practitioner,"
Dr. Watson S. Rankin, Wake Forest.

129. "Toxic Changes from Prolonged Use of Acetanilid," Dr. H. H.
Clapp, Winston.

Section on Railway Surgery — Dr. C. A. Julian, Chairman,
Thoina-sville.

130. "Railway Surgery," Dr. C. A. Julian, Thomasville.

131. "The Railway Surgeon and What is Expected of Him by This
Company," Dr. W. A. Applegate, Chief Surgeon Southern Railway,
Washington, D. C.

132. "Lacerations of the Hand," Dr. Robert S. Young, Concord.

133. "Conservatism in Railway Surgery," Dr. W. P. Whittington,
Asheville.

134. Subject to be announced. Dr. J. T. J. Battle, Greensboro.

135. Subject to be announced, Dr. Geo. G. Thomas, Wilmington.

Section on Pathology and Microscopy — Dr. Ben E. Hays, Chairman,

Oxford.

136. "Metchnikoft's Theory of Old Age," Dr. Ben K. Hays.

SYNOPOSIS OF THE TRANSACTIONS

OF THE

Medical Society of the State of North Carolina

FIFTY-FIFTH ANNUAL MEETING
Winston-Salem, N. C, June 16, 17, 18, 1908.

The fifty-fifth annual meeting of the iSTorth Carolina Medi-
cal Society met in the Forsyth County court-house at Winston-
Salem, on the 16th day of June, at 10:30 a. m., 1908, the
Society remaining in session for three days.

Three hundred and seventy-two members registered, mak-
ing this the largest gathering in the history of the organiza-
tion, except the Charlotte session of 1906, which registered
thirty-four more.

The Convention was called to order by Dr. W. O. Spencer.
Chairman of the Local Committee of Arrangements.

Eev. H. A. Brown, D.D., delivered the divine invocation.

Dr. Spencer then introduced to the Society the Mayor of
Winston, the Hon, O. B. Eaton, who, in a strong address,
warmly welcomed the Society, singly and collectively, and
turned over to them the keys of the city.

Dr. Pridgen, of Ivinston, on behalf of the Society, re-
sponded to the Mayor's address, warmly thanking him and
the Forsyth County Medical Society for their generous wel-
come, and then gave an interesting sketch of the old town of
Salem, from the time it was a cross-roads to the present time.

At the conclusion of Dr. Pridgen's address. Dr. Spencer
introduced to the Society its President, Dr. J. Howell Way.
of Waynesville, for four years the Secretary of the organi-
zation.

Dr. Way, in his address, briefly outlined the early struggles
of the Society and touched upon the history and growth of
the organization, which, from a mere handful of members

22 FIFTY-FIFTH ANNUAL SESSION

fifty-five years ago, has become the splendid organization
which it now is, numbering upon its membership roll nearly
thirteen hundred men. The President's address showed years
of study, observation and careful research and is of interest
and value to the members of the Society.

De. Burroughs, at the close of the President's address,
said: Mr. President: I wish to move that our Secretary ap-
point a committee of three, to report at some future time on
the President's address, during the meeting.

Dr. Weaver: I believe it is customary for the President's
address to be referred to the House of Delegates for future
consideration. I move, therefore, that it be referred to the
House of Delegates, where a sj^ecial committee will be ap-
pointed for the consideration of the address.

Dr. Burroughs: I don't think that is the way, exactly,
it should be done. I accept your amendment, though.

The President: "Without objection the President's ad-
dress is referred to the House of Delegates.

Gentlemen, we will now proceed to the consideration of the
Section of Anatomy and Surgery, Dr. Joshua Tayloe, of
Washington, N. C, Chairman.

"Diagnostic Value of Exploratory Incision, With Case
Cited," Dr. Joshua Tayloe. (Paper read.)

Dr. Parrott: Mr. President: As this paper is included
in the section of surgery, I move that the courtesy of the floor
be extended to Dr. Stuart McGuire, of Eichmond, our distin-
guished visitor. Motion carried.

"Some Points of Minor Surgery," Dr. W. J. McAnally,
High Point. (Read by title.)

"Ligation of the Femoral Artery Eight Hours After In-
jury— Eesults," Dr. J. R. Paddison, Oak Ridge. (Read.)

Discussed by Drs. Parrott, Kent and J. P. Turner.

"Orthopaedic Surgery, a Plea for the Crippled and De-
formed Children of N'orth Carolina," Dr. J. L. Haines, of
Winston. (Read.)

j!^. c. medical society. 23

Discussed bj Dr. Whittington.

"Some Practical Thoughts on Hernia," Dr. K. L. Hayne,
jSTorfolk, Va. (Eead.)

Discussed by Drs, McGuire, Weaver and M. Bolton.
Society here took a recess until 2 :30 p. m.

Tuesday Afterxoois^, June 16th,

Convention called to order by the President, Dr. Way.

The initial paper of the afternoon was read by Dr. J, W.
Long, of Greensboro — "Mesenteric Thrombus Following
Splenectomy."

The President here resigned the chair to Dr. J. E. Stokes,
Vice-President, as it was necessary for him to attend a meet-
ing of the House of Delegates.

Dr. Long's paper discussed by Dr. W. S. Rankin, of Wake
Forest.

Dr. Williams : Would it be in order for the Board of
Examiners to make a report now ?

The Chairman put the motion to the Society, and it was
carried.

Dr. Sikes read the report of the State Board of Medical
Examiners.

Chairmax : What shall we do with the report, gentlemen ?

Dr. Williams : I move that it be received. Motion car-
ried.

''Excision of the Coccyx," Dr. John E. Irwin, Charlotte.
(Read by title.)

''The Surgical Conscience," Dr. John C. Rodman, Wash-
ington, D. C. (Read.)

Discussed by Drs. Francis Duffy and J. A. Williams.

"Etiology, Symptoms, Diagnosis and Treatment of Empye-
mia, with Report of Thoractomy," Dr. J, T. Burrus, High
Point. (Read.)

Discussed by Drs. Rodman, Burroughs, J. F. McKay and
L. A. Crowell.

24 FIFTY-FIFTH ANNUAL SESSION

"Hydrocele," Dr. E. C. Moore, Elm City, X. C. (Read.)

Discussed by Drs. McGuire and J. W. Long.

"The General Practitioner as a Surgeon," Dr. Edmund
Harrison, Greensboro, IST. C. (Read.)

"Traumatic Aneurism, with Report of a Case," Dr. J. B.
Gibbs, Lexington, IT. C. (Read by title.)

"An Interesting Case of Gangrene," Dr. K. P. B. Bonner,
Morehead City, :N. C. (Read.)

"Cancer as We View It To-day," Dr. W. O. Spencer,
Winston, IT. C. (Read by title.)

"Coxa Vera," Dr. Wm. Moncure, Raleigh, :K. C. (Read.)

"Conservative Surgery," Dr. Joseph Akerman. Wilming-
ton, 'N. C. (Read.)

"The Value of Ante-operative Tests," Dr. C. M. Strong,
Charlotte. (Read by title.)

"An Interesting Case of Stone in the Bladder," Dr. James
M. Parrott, Kinston, N. C. (Read.)

"The Importance of Early Treatment of the Mastoid Com-
plications of Middle Ear Disease," Dr. J. M. Lilly, Fayette-
viUe, N. C. (Read.)

"Abscess of the Brain," Dr. R. G. Buckner, Asheville.
IT. C. (Read.)

"The Influence of the Constitutional Condition of the Pa-
tient on the Results of the Operation," Dr. Stuart McGuire,
Richmond, Va. (Read.)

Discussed by Dr. Whittington.

"Carbuncle, Its Etiology, Pathology and Treatment, Par-
ticularly the Latter," Dr. T. E. Anderson, Statesville, H^. C.
(Read.)

Dr. Wood : Before we discuss this paper, I desire to say
that I take great pleasure in announcing to the Society that
we have with us Dr. C. L. Lavinder, of the U. S. P. H. and
M. H. Service, who is stationed in Wilmington, and I move
that he be given the privileges of the floor.

The Society extends invitation to all visitors to participate
in the discussions.

K". C. MEDICAL SOCIETY. 25

Dr. Anderson's paper discussed by Drs. McGuire, M. F.
Fox, and Weaver.

"Endo-aneurismorrliaplij/' (Matas), Dr. Thos. M. Green.
Wilmington, X. C.

Discussed by Dr. Lavinder.

"Appendicostomy in Amoebic Dysentery, Report of a
Cure," Dr. Brodie C. Xalle, Charlotte, X. C. (Read by
title.)

The Society here took a recess until S :30 Tuesday evening.

MEMORIAL SERVICES.

Tuesday Evexi^s'g, June 16th.

President called the Society to order at 8 :30 p. m., for the
Memorial meeting, introducing Dr. Julian, Chairman of the
Obituary Committee, who read his report:

Papers bearing on this subject by Drs. —

R. H. Lewis — ''In Memoriam, Patrick Livingston Mur-

R. G. Thomas — "In Memoriam, Patrick Livingston Mur-
phy."

G. M. Cooper, Clinton— ''Life and Works of Dr. P. L.
Murphy."

A. W. Knox— "Memorial, Dr. P. L. Murphy."

H. T. Bahnson— "A Little Tribute to Dr. Joseph Gra-
ham."

DISCUSSIOX.

Dr. Maesh, Dk. Sikes: Will the chair entertain a mo-
tion here to-night in regard to Dr. Murphy's life and the
Transactions ?

The President : With pleasure.

Dr. Sikes: As Dr. Murphy was originally from our
county, and I represent that county at this meeting, I would
like the Chair to entertain this proposition: that a photo-

26 FIFTY-FIFTH ANNUAL SESSION

graph of Dr. Murphy be put in the Transactions along with
the minutes of this meeting.

The President : Without objection that will take the
usual order of business such as this, and be referred, without
debate, to the House of Delegates, which will, without doubt,
act upon the advice.

The suggestion approved by Drs. K. G. Averitt and Rose.

Dr. Ben K. Hays asked that a motion be entertained pro-
viding that the papers read at the Memorial Service be printed
in the leading daily papers of the State on Sunday. Motion
carried.

Dk. Marsh: Mr. President: The State Board of Health
will meet immediately in room 20-i at the Zinzendorf Hotel.

The President instructed the Secretary to make a note of
the motion just passed and to see that the Sunday papers were
provided with the memorial tributes.

The President here announced that the House of Delegates
would meet in the Municipal Building in the City Hall at
8 :30 sharp, Wednesday morning, and that the general meet-
ing would come to order in the court-house at 9 o'clock.
Also that the election of the Board of Examiners would take
place at 10, Wednesday morning, in the general session.

Convention here took a recess until 9 o'clock Wednesday
morning.

Wednesday Morning, June 17th.

In the absence of the President in attendance on the House
of Delegates, the Convention was called to order by Dr. C. A.
Julian, Vice-President.

First paper read by Dr. Eugene B. Glenn, of Asheville,
^'Enchondromata and Report of Case Undergoing Malignant
Degeneration."

''The Importance of Work of the General Practitioner,"
Dr. L. B. McBrayer, Asheville, I^. C. (Read.)

X. C. MEDICAL SOCIETY. 27

The Peesidext, Dr. Wav, resumed the chair at 10 o'clock
and made the following announcement:

Gentlemen, the hour for the special order of the election of
the Board of Medical Examiners has arrived, and I now an-
nounce that the duty is before you.

The Sanitary Engineer of Winston-Salem here extended an
invitation to the members of the Association to inspect the
waterworks and especially the new system of filtration.

Dr. J. Roy Williams, of Greensboro, sought at this junc-
ture to present a matter from the Guilford County Medical
Society, but was overruled as being out of order, on account
of the matter of the election of the Medical Examiners being
before the Society.

The election of the Board of Examiners was gone into.
Short nominating speeches, of two minutes each, were made
by Drs. Turner, Duffy, Lewis, Albert Anderson, Monroe,
C. W. Mosley, JSTicholson, Weaver, Stanton, Crowell of Lin-
colnton, Thomas, Monk, Dickerson, Stevens, Lockett, A. B.
Groom, Harris, Booth, Cranmer, J. E. Brooks, Burns, John
Roy Williams, A. S. Rose, Glenn of Asheville, Harper and
Long.

Doctors Xicholson, Dodson, McKenzie, Hays and Mc-
Brayer were elected on the first ballot. Dr. Rodman being
the only one receiving a sufficient number of votes to elect, on
the second ballot, it was decided that on the third ballot the
nominee receiving the highest number of votes should be con-
sidered as elected. On this ballot Dr. Bynum was elected.

The Society then took a recess until 3 o'clock, on motion of
Dr. Lewis.

Wednesday Afterxook^, June 17th.
The President callerl the Society to order at 3 o'clock, and
introduced Dr. Thomas, President of the State Board of
Health. The conjoint meeting of the Society and the State
Board of Health was held. Dr. Thomas presiding.

28 FIFTY-FIFTH ANNUAL SESSION

Dr. Kichard H. Lewis, Secretary of tlie State Board of
Health, read his report.

Dr. Thomas introduced Dr. Charles Wardell Stiles, Chief
of the Department of Zoology, "Washington, D. C, who read
a paper entitled, "Soil Pollution, With Eeference to Hook
Worm Disease."

Dr. Stiles's paper discussed by Drs. Julian and Lewis.

Paper read by Dr. Tait Butler, State Veterinarian, Ra-
leigh, entitled "Milk Supplies in Relation to Public Health."

Discussed by Drs. Von Ruck and Burroughs.

The section of "Pellagra" was next taken up, papers being
read as follows:

"Pellagra, Its ]S"ature, History and Appearance in This
Country," Dr. Edward J. Wood, Wilmington, ]^. C.

"Pellagrous Insanity," Dr. John McCampbell, Morganton.

Dr. Sikes here arose to introduce a motion of order in the
house, and was seconded by Dr. Rankin.

Dr. Jewett, on behalf of the Local Committee of Arrange-
ments, announced that the ladies would have a supper at the
park that night, and that tickets were at the disposal of any
one who desired to attend.

Paper read by Dr. Lavinder, U. S. P. H. and M. H. S.,
entitled "Etiology and Pathology of Pellagra."

The foregoing papers on Pellagra discussed by Drs. Whit-
tington, L M. Taylor, Stiles, and W. S. Rankin.

Dr. Dalton: I would like to make the announcement
that we have a supper over at ISTissen Park, prepared for the
Society, which will be ready at seven-thirty, and as soon rs
you adjourn you can take the cars going south at once.

De. Thomas : It is not necessary for me to repeat such a
pleasant invitation as that. I am sure it will appeal to you.
If there is no more business before the conjoint session, we
will now adjourn. The conjoint session is now adjourned.

The President : Dr. Way, Gentlemen: It is moved
and seconded that this Societv take a recess until the con-

N. C. MEDICAL SOCIETY. 29

elusion of the supper at the park to-night, at which time the
annual oration and annual essay will be delivered.
The Society now stands adjourned.

The members of the Society took the cars to Xissen Park,
where an elegant supper was served by the ladies of the Hos-
pital Committee. The dining room was beautifully decorated
with a profusion of cut flowers, and music was rendered dur-
ing the repast by the Winston band. ISTeedless to say this
was one of the most enjoyable events of the three days' meet-
ing of the Society.

Dr. J. Allison Hodges, of Richmond, Va., honorary mem-
ber, and a ISTorth Carolinian, was pressed for a speech, which
he made at the conclusion of the supper, in his usual happy
style.

The Society met at the pavilion at the park at S :oO, and
was called to order by the President, Dr. Way, who intro-
duced Dr. Charles S. Mangum, of Chapel Hill, the orator.

Dr. Mangum delivered the annual oration, ''The Physician
and Education," and was much applauded at its conclusion.

The President introduced Dr. Thomas R. Little, of Greens-
boro, who read the annual essay, "The Lines of Progress in
the Practice of Medicine." This essay was also heartily ap-
plauded.

The President made a little speech, thanking the ladies for
their presence, and introduced Dr. Lewis, Secretary' of the
State Board. of Health, who regaled the crowd with several
funny stories, much to their delight.

The President adjourned the meeting, and asked the So-
ciety to reassemble at the place of meeting at the court-house,
Thursday morning, at 9 o'clock.

30 FIFTY-FIFTH ANNUAL SESSION

Thuesday Morning, June 18th.

Society called to order by the President.

Dr. Frank Duffy asked to present a resolution on behalf
of Dr. J. A. Reagan, one of the Society's oldest members ;
that the Society regretted his illness, which prevented his
being present at the meetings, and that it sympathized with
him in his affliction.

The resolution was adopted.

First paper on the morning's program read by Dr. J. E.
Stokes, of Salisbury, ''The Relation of the General Practi-
tioner to Gynecology."

This paper was discussed by Dr. Weaver.

Motion made by Dr. J. T. J. Battle that a committee of
three be appointed to confer with the Publication Committee
of the Society "in regard to some apparent discrepancies in
the different prints of the Constitution and By-Laws of the
Society."

Drs. Fletcher, Battle and Kent appointed on this commit-
tee. Dr. Kent being made chairman of the same.

Dr. Turner here brought up a matter from the Guilford
County Medical Society in regard to an alleged "unethical"
advertisement in the Charlotte Medical Journal, which was
referred by the President to the Council.

The President filled the vacancies of the Council, and it
was requested to sit and hear the matter, in the presence of
the assembly. Dr. I. M. Taylor, of Morganton, was elected
President of the Council. Dr. Parrott was asked to serve
but was too unwell to do so. The personnel of the Council
was as follows : Dr. I. M. Taylor, President ; Dr. Sam
Stevens, Secretary; Drs. Chas. O. H. Laughinghouse, Chas.
T. Harper, E. T. Dickerson, J. F. Highsmith, L. B. Mc-
Brayer and A. W. Knox.

The matter was discussed at leng-th by the various members
of the Council, Drs. Williams, Beall, Long and Turner, of
the Guilford County Medical Society ; and Dr. Bahnson, who

N". C. MEDICAL SOCIETY. 31

finally submitted a resolution to the Society that the Char-
lotte Medical Journal should offer explanation and apology
for the "unethical" advertisement. This resolution was
finally adopted by the Society.

The consideration of regular program resumed.

"Obstetrical "Work, From the Standpoint of the General
Practitioner." (Read by Dr. J. A. Croom, of Maxton.)

"The Relation of the General Practitioner to Surgery,"
Dr. T. E. W. Brown, of Asheville. (Read by title.)

"The Relation of the Laboratory to the General Practi-
tioner." (Read by Dr. Watson S. Rankin, of Wake Forest.)

Discussed by Dr. Fletcher, of Asheville.

"The Relation of the General Practitioner to the Opthal-
mologist," Dr. Gaillard S. Tennant, Asheville, I^. C. (Read
by title.)

"Pain in the Abdomen and What It Means to the General
Practitioner," Dr. Henry F. Long, Statesville, [R. C. (Read
by title.)

"Manners in the Sick Room," Dr. C. S. Jordan, Asheville.
K C. (Read by title.)

Upon motion of Dr. Rankin, the Convention took a recess
until 3 p. m.

Thursday ArTEExooisr, June ISth.

First paper on the program :

"The Results of Surgery as Seen by the General Practi-
tioner, iN'ot Being an Adverse Criticism," Dr. J. Allison
Hodges, Richmond, Ya.

Discussed by Drs. Highsmith and Joseph Graham.

Upon motion of Dr. Haines, a vote of thanks was extended
by the Society to Dr. Hodges for his most excellent and
timely paper.

"Report of a Case Treated with Ichthyolated Emulsion
Compound," Dr. John Roy Williams, Greensboro. (Read
by title.)

32 FIFTY-FIFTH ANNUAL SESSION

"Vacciiie or Tuberculin Therapy in the Treatment of
Tuberculosis," Dr. H. B. Weaver, Asheville, :N". C. (Eead.)

Motion by Dr. Wm. A. Grier that all papers on the same
subject as Dr. Weaver's be discussed together, after all are
read.

Motion carried.

"The Importance of Early Diagnosis in the Successful
Treatment of Tubercular Affection," Dr. Daniel A. Dees,
Bayboro. (Eead by title.)

"The Turn of the Tide of Tuberculosis Mortality," Dr.
M. L. Stevens, Asheville. (Read by title.)

''Our Greatest Xeed in the Successful Treatment of Tuber-
culosis," Dr. E. L. Stanley, Greensboro. (Read by title.)

"Tuberculin Therapy," Dr. C. S. Grayson, High Point.
(Read by title.)

"Early Tuberculosis and Malaria, Their Differentiation,"
Dr. Paul H. Ringer, Asheville. (Read by title.)

"The Treatment of Incipient Tuberculosis," Dr. J. E.
Brooks, Greensboro. (Read.)

"The Use and Abuse of Drugs in Tuberculosis," Dr. W.
M. Jones, High Point. (Read.)

"Outdoor Life in the Treatment of Respiratory Troubles
and Some Other Matters," Dr. Paul Paquin, Asheville.
(Read by title.)

"A Few Suggestions for Those Suffering from Tubercu-
losis," Dr. Wm. R. Kirk, Hendersonville. (Read by title.)

"Diagnosis of Acute Miliary Tuberculosis," Dr. Silvio von
Ruck, Asheville. (Read by title.)

"The ISTecessity of Quarantine in Pneumonia," Dr. Chas.
Wilkerson, Apex. (Read by title.)

The President: Gentlemen: I believe it is now in
order to call for discussions on the tuberculosis papers that
have just been read. Is there any discussion of these papers ?

Discussions by Doctors Stiles, Diinn, Brooks and Weaver.

"Childhood, With Its Exacting Cares and Responsibili-

N^. C. MEDICAL SOCIETY. 06

ties and Glorious Eesiilts," Dr. I. W. Faison, Charlotte, IST.
C. (Eead by title.)

''Influenza," Dr. J. H. Merritt, Woodside. (Read by
title.)

"Acute Rheumatism," Dr. L. B. Young, Robbinsville.
(Read by title.)

"Report of a Case of Typhoid Cholecystitis," Dr. AV. A.
Graham, Durham. (Read.)

Discussed by Dr. Highsmith.

''Venesection, Its Indications and Uses as a Therapeutic
Agent," Dr. Wm. Lyday, Penrose, jST. C. (Read by title.)

•']\Iilk Sickness," Dr. J. A. Reagan, Weaversville, iST. C.
(Read by title.)

"A Practical Study of Epilepsy," Dr. E. S. Warlick, Mor-
ganton, ]^. C. (Read by title.)

"The Examiner's Golden Rules for Life Insurance Work,"
Dr. Albert Anderson, Raleigh. (Read by title.)

''Reciprocity Between the State Examining Boards," Dr.
A. A. Kent, Lenoir. (Read by title.)

"The Role of Moral Trauma in Producing Physical Dam-
age," Dr. R. S. Carroll, Asheville, ]S^. C. (Read by title.)

"Bright's Disease; Hydrastis in the Treatment of," Dr.
Francis Duffy, New Bern. (Read.)

"A More Liberal Use of Hydrastis in Kidney Troubles,"
Dr. R. A. AYhitaker, Kinston, N. C. (Read by title.)

''Some Atypical Forms of Malaria," Dr. J. W. P. Smith-
wick, LaGrange. (Read by title.)

"Treatment of Typhoid Fever," Dr. T. C. Quickel, Stan-
ley. (Read by title.)

"Epidemic of Malignant Cholera as Observed in the Phil-
ippine Islands," Dr. C. G. Bryant, Spruce Pine. (Read by
title.)

"Application of Dietetics in Acute and Chronic Intestinal
Infections." (Read by title.)

"A 'New Method of Shortening an Ocular Muscle, With

34 FIFTY-FIFTH ANNUAL SESSION

Exhibition of Instruments," Dr. H. H. Briggs, Aslieville.
(Eead by title.)

"Early Recogtiition and Treatment of Toxic Amblyopia
as Caused by the Abuse of Tobacco and Alcohol," Dr. Henry
Honnett, Wilmington. (Read by title.)

"Influenzal Arthritis," Dr. James J. Philips, Tarboro,
K C. (Read.)

The Pkesidext: I have to offer apologies to the doctor
and the Society for not inviting discussion of his paper. The
small numbers and the growing lateness make it necessary
that I now request the Secretary to make a report from the
House of Delegates.

(Report read. See index for report.)

Telegrams received from Drs. Southgate Leigh, of Nor-
folk, and David Tayloe, of Washington, expressing their re-
grets at their inability to be present at the meeting. Also
telegrams from the Chamber of Commerce and from the
Mayor of the city of Wilmington, inviting the Association
to meet at Wrightsville Beach next year.

The President, in a little speech to the Society, thanked
them for their kindness and support during the past year,
and expressed his appreciation of the honor of being their
President, and requested Drs. A. W. Knox and H. B. Weaver,
two ex-Presidents, to escort the President-elect, Dr. J. F.
Highsmith, to the chair.

Dr. Knox replied to the President, warmly eulogizing liis
efficiency, and then with Dr. Weaver escorted the President-
elect to the chair. Dr. Highsmith was presented to the
President by Dr. Weaver.

The President then introduced the President-elect to the
Society and retired from the chair.

Dr. Highsmith made a brief speech of acceptance, in
Avhich he warmly thanked the Association for the unexpected
honor, and asked the individual support of the members
during his year of office.

Dr. Weaver moved that the remaining papers be read hy

N. C. MEDICAL SOCIETY. 35

title, as it was late, and the remaining members desired to
leave for their homes. This motion was carried.

The other papers read by title are as follows :

"Perforation and Peritonitis Complicating Typhoid
Fever," Dr. Edwin C. Register, Charlotte.

"Personal Views on the Treatment of Typhoid Fever," Dr.
C. E. Eeitzel, High Point.

"Aerostatic Deafness, Its Etiology and Treatment," Dr.
W. P. Eeaves, Greensboro.

"To Be Eather Than Seem," Dr. Is^. C. Hunter, Eocking-
ham.

"The Eational Trend of Modern Therapeutics," Dr. L. iN".
Glenn, McAdensville.

"Cathartics," Dr. M. A. Eoyall, Yadkinville.

"The Importance of Proper Dosage in the Administration
of Quinine," Dr. Parran Jarboe, Greensboro.

"J^ormal Salt Solution, Its Use and Method of Administra-
tion," Dr. C. A. Woodard, Durham.

"A Brief Eeport of Some Cases "\^Tiich Have Yielded Sur-
prisingly to X-Eay Treatment Aided by Snow's Tubes and
Mechanical Vibration," Dr. J. Thomas Wright, Winston-
Salem.

"Anesthetics," Dr. Southgate Leigh, Xorfolk, Va.

"Adrenalin Chloride, Its Use in Medicine," Dr. C. O. Aber-
nethy, Ealeigh.

"The Use and Abuse of Morphine and Kindred Drugs,"
Dr. D. A. Garrison, Bessemer City.

"Therapeutics an Art," Dr. W. H. Boone, Morrisville.

"A Plea for Fewer and Simpler Eemedies," Dr. John Hill
Tucker, Henderson.

"A Plea for Early Operation in Appendicitis When the
Diagnosis is Obscure," Dr. J, F. Highsmith, Fayetteville.

"Hysterectomy With Eeport of a Case," Dr. Eigdon O.
Dees, Greensboro.

"Surgery of the Stomach," Dr. W. F. Faison, Jersey City.
Is^. J.

36 FIFTY-FIFTH ANNUAL SESSION

"Imperforate Hymen Witk Eeport of a Case," Dr. S. C.
Highway, Murphy.

"Diagnosis and Treatment of Ectopic Gestation From the
Standpoint of a Country Doctor, With Report of Case," Dr.
G. F. Duncan, High Point.

"Demand for Early Surgical Interference in Pernicious
Vomiting of Pregnancy," Dr. J. A. Williams, Greensboro.

"The Things That Kill Women in Childbearing, and How
and Why," Dr. H. D. Stewart, Monroe.

"Management of Labor," Dr. J. W. McGehee, Eeidsville.

"Puerperal Eclampsia," Dr. E. E. Strickland, Bethania.

"Hydatidiform Mole, With Report of a Case," Dr. J. B.
Cranmer, Wilmington.

"Cesarean Section With Report of Case," Dr. H. McKee
Tucker, Raleigh.

"History of a Case of Hydatidiform Mole," Dr. J. M.
Williams, Warsaw.

"The Management of the Third Stage of Labor," Dr. B.
R. Graham, Wallace.

'.'Maternal Nursing," Dr. W. W. McKenzie, Salisbury.

"An Artificial Eood Suitable for Young Infants," Dr.
Chas. Roberson, Greensboro.

"Scarlatiniform Eruption," Dr. J. S. Brown, Henderson-
ville.

"Pneumonia in Children," Dr. J. A. Turner, High Point.

"Ilieo-colitis," Dr. H. L. Monk, Spencer.

"Diphtheria and a W^rd for Antitoxin," Dr. E. M. Hutch-
ens, Boonville.

"Adenoids in Children, Etiology, Symptoms and Sequela,"
Dr. J. B. Wright, Lincolnton.

"Post-scarlatinal ISTephritis," Dr. W. J. Meadows, Greens-
boro.

"Acute Gastro-intestinal Intoxication Without Diarrhoea
in Children," Dr. S. A. Wilkins, Gastonia.

"Pleurisy in Children," Dr. J. R. McCracken, Waynesr
ville.

If. C. MEDICAL SOCIETY. 37

"Clinical Eeport of a Case of Pser.do-leucocythemia In-
fantum," Dr. W. M. Jones, High Point.

"Artificial Interruption of the Physiological Circulation
as a Therapeutic Measure, Dr. E. T. Dickinson, Wilson.

"The Physiology of the Kidney and the Essential Exami-
nation of the Urine," Dr. I. W. Lamm, Lucama.

"The Importance of a Thorough Knowledge of Biology,
Bacteriology and of the Circulation of the Blood for the Suc-
cessful Application of Serum Therapy," Dr. J. C. Grady,
Kenly.

"The Necessity of Chemical Examination of the Stomach
Contents in Gastro-intestinal Diseases," Dr. C. W. Moseley^
Greensboro.

"The Relation of the Laboratory to the General Practi-
tioner," Dr. Watson S. Eankin, Wake Forest.

"Toxic Changes From Prolonged Use of Acetanilid," Dr.
H. H. Kapp, Winston.

"Railway Surgery," Dr. C. A. Julian, Thomasville.

"The Railway Surgeon and What Is Expected of Him by
This Company," Dr. W. A. Applegate, Chief Surgeon South-
ern Railway, Washington, D. C.

"Lacerations of the Hand," Dr. Robt. S. Young, Concord.

"Conservatism in Railway Surgery," Dr. W. P. Whit-
ting-ton, Asheville.

Subject to be announced, Dr. J. T. J. Battle, Greensboro.

Subject to be announced. Dr. Geo. G. Thomas, Wilming-
ton,

"Metchnikoff's Theory of Old Age," Dr. Ben K. Hays,
Oxford.

Dr. R. D. Jewett at this juncture offered a motion that
three members be appointed to look into the advisability of
publishing the Minutes of the Society in a monthly journal,
to be owned by that body, instead of in the bound Transac-
tions, as heretofore. Seconded, and urged by Dr. Whitting-
ton and others.

38 FIFTY-FIFTH ANNUAL SESSION

Dr. Way made a motion that tlie Society adjourn, which
•vvas seconded by Dr. Weaver. This was opposed by Dr.
Whittinglon, and insisted upon by Dr. Way, for the reason
that as a business matter it properly came before the House
of Delegates, which had adjourned, and besides almost every-
body had left the meeting, and the fcAV remaining members
should not take action upon so important a matter without
the sanction of the rest of the Society.

The President requested all w^ho were in favor of adjourn-
ing to rise, and, upon counting those who were standing, it
was found that fifteen were in favor of adjourning, while
thirteen retained their seats. The majority being in favor of
adjourning, the President declared the meeting adjourned
sine die.

If. C. MEDICAL SOCIETY. 39

OPENING INVOCATION

By Rev. Dr. H. A. Brown, Winston, N. C.

We lift up our hearts iu humble petitiou and in gratitude
to thee, our Heavenly Father, that thou hast granted us the
privilege of gathering together again in this annual meeting.
And now we beg that thy benediction and blessing may
abide with us all. Mayest thou preside over us as the Great
Physician, and may the meeting of this profession be for the
welfare of the people of our beloved State.

We thank thee for the wonderful progress in medical
science that has been reached by thy people, and we pray
thee, O Lord, that thou wilt continue to bless these who are
engaged in this noble profession, and give them that measure
of success that will redound to thy glory and to the welfare
of thy people.

We ask thee, O gracious Lord, that thou wilt take each one
of these men and make him an instrument in thy hand for
the furtherance of thy cause upon the earth. O thou, who
wast thyself the Great Physician when upon the earth, who
didst heal the diseases of the body, as well as of the soul, wilt
thou put thy loving hand upon each one of these men and
make them a blessing wherever they may be. Grant that
these men, as they come in and out of our homes, may have
an influence for good in our families and our communities.

We pray that thou wilt bless them while they are within
our gates and grant them a safe return to their people.

O Lord, save us and bless us. Make this meeting a great
power for good, and as these men shall confer, one with an-
other, and read their papers, may greater light come into
their minds, and may each of them go back home the better
prepared to meet with the trials and with the great questions
that shall present themselves to them.

Bless us all together, for Jesus' sake. Amen.

40 FIFTY-FIFTH ANNUAL SESSION

ADDRESS OF WELCOME

By Hon. O. B. Eaton, Mayor of Winston-Salem.

Mr. President, Officers and Members of the North Carolina
Medical Society, Ladies and Gentlemen:

It is with emotions such as I have never experienced upon
any former occasion that I greet you at this, your annual
meeting, and extend to you, on behalf of the whole people of
our city, a most cordial and hearty welcome, coupled with
the wish that one and all shall feel that it is meet and proper
to be here, and that the work of your organization shall have
been strengthened and advanced by your deliberations.

You have met here to review the events of the past year
affecting your organization, to note its progress, to counsel
and advise with one another how you can best serve and pro-
mote its interests, properly widen and enlarge its sphere of
usefulness, so that the Society and individuals may have the
highest development and the largest allotment of human
happiness.

We have many times had the pleasure of entertaining dis-
tinguished bodies of men, representing the religious, fra-
ternal, commercial and professional interests of our State, but
this is the first time that we have had the honor of enter-
taining an organization, the origin and the purpose of which
is to lay plans and devise ways and means to better alleviate
human suffering, restore health and direct the energies of
the weak to a higher and a nobler plane of living.

We therefore Avelcome you, because you are representa-
tives of a great and growing organization, created by the ne-
cessities of your profession and by the genius of men who
have invented, step by step, the methods which are indis-
pensable in modern practice, without which you could not
undertake to do what your Society is accomplishing every
day.

2^. C. MEDICAL SOCIETY. 41

Of course the most essential part of your great organiza-
tion is not the organization itself; it is the intelligence, the
brains, the sense of truth and honor that reside in the men
who conduct it and who are making it a vehicle of usefulness
and an unliftiug povrer for good in the State.

We welcome you, gentlemen, because you constitute one
of the most useful and important classes of society, and be-
long to a profession that calls for these qualities that make
for the highest manhood ; calls for a clear head, a steady hand,
a stout heart, and those innate attributes that mark the true
gentleman.

You rightfully belong to the great fraternity of working
men, bred and born to work, and this honorable mark, written
upon your brows by the hand of the Almighty, identifies you
with all classes of working men, whether of hand or brain.

Sancho Panza said : '"Blessings on the man who first in-
vented sleep" ; but I say, "Blessings on the man who first
discovered medicine, and blessings on the men who practice
it." (Applause.)

Commerce, we all know, is the vanguard of civilization,
and wherever commerce goes there must go the blessings of
science and of the arts, and among them there is none greater
than the science of medicine, for whatever conduces to
health makes men wiser and better, improves our civilization
and lifts us to a higher and a better life. The best physical
and mental efforts are obtained from healthy minds and
bodies, and in order to have these we must have skilled men
to direct in the care and preservation of them. Thousands
of men and women are to-day moping around with sallow
faces and lusterless eyes, grunting and groaning with all sorts
of imaginary ills, that simply need the touch of a doctor's
hand and the torture of a doctor's medicine. It is marvelous,
the change that comes over a man who has been cleansed and
thoroughly renovated by an up-to-date doctor. It makes him
a better father, a better citizen, a higher class and better

42 FIFTY-FIFTH ANNUAL SESSION

working man, with greater appreciation of the blessings and
comforts of life.

Mr. President and gentlemen, we welcome you because
your profession is an absolute necessity for the comfort and
well-being of mankind.

" We can live without poetry, music and art ;
We can live without conscience; we can live without heart ;
We can live without friends ; we can live without books ;
But civilized folks can not live without doctors."

(Applause.)

There is no world so dark and dismal and narrow as the
one in which the poor dysj)eptic lives, and when a doctor
leads one of those wretched men out of that world into the
bright and hopeful realm of health he carries him to a sort
of heaven on earth ; he scatters sunshine ; he scatters joy and
gladness ; he scatters health and happiness ; he sweetens the
moments, the thoughts, the feelings, the temper and the
heart ; he renews on earth lost Eden's faded bloom, and flings
hope's halcyon halo over the wastes of life.

Sympathy and help, in times of need, radiate from the
person of a good doctor, as love glows from the brow of a
good woman. He goes do\m to the dark places; he lives in
memories of hand-to-hand battles with death ; he wards away
despair, and when the fight is lost he goes out with an infinite
pathos in his face of one beaten an hundred times, to be
beaten yet again — knoAvs nothing and believes nothing — sur-
renders to the inevitable.

In honor of a common cause and in the presence of a com-
mon danger men have offered upon their country's altar the
rich libations of their blood, and their names have been em-
balmed in story and in song. But no hero, on any land or
sea, ever displays more courage or loyalty to duty than the
brave doctor who responds to the midnight call, faces the
storm in the night, cools the fevered brow of pain, beats back
death from the humble home, and brings sunshine and hope

N. C. MEDICAL SOCIETY. 43

to the despairing soul. No surveyor's chain has ever marked
the boundaries of his love for humanity, and no plummet
ever sounded the depths of his loyalty and devotion. Such
service makes its appeal and wins the unspeakable gratitude
of man.

Mr. President and gentlemen, Ave welcome you not only
because your mission in life is to alleviate human suffering,
but because you are becoming more and more a mighty fac-
tor in the development of our business life and energy, and
because you are making life sweeter and better by your con-
tact and associations with men. From the great fountain of
charity in your souls there flows a thousand streams of bless-
ings to suffering humanity. Your influence and your min-
istrations in the home make a world of joy and smooth a
world of sorrow, and linger around our firesides in all the
dearest and sweetest associations of life; upon it hangs the
hopes and happiness of the nations of the earth; above it
shines the ever-blessed star that lights the pathway back to
the paradise that was lost ; it stands beside the toiler in the
shops, and lends pathos to the ring of the anvil ; it goes with
the toiler of the field and lends beauty and softness to the
great chorus of nature ; it goes w^ith the man who drives the
plow and pushes the plane and swelters at the forges and in
the factories, and helps to roll back earth's tide of withering
gall, dry up her dark fountains of grief and turn Iliads of
woe into bright songs of gladness.

Mr. President, it is not the philosopher, the scientist, or
even the preacher who alone are making the world better,
but the doctor who comes into the most intimate relations
with the family and, by a single word, sows the seed.

Gentlemen, home is the basis of society and good govern-
ment, the foundation of the family and of all true, useful
church life. Who can estimate the power and the influence
of the doctor in the home ? It is said that a little pebble
dropped upon the shore starts in motion little wavelets that
break upon the farther shore. And is it not true that the doc-

44 FIFTY-FIPTH ANJfUAL SESSION

tor's influence in the borne starts in motion the waves of the
moral atmosphere that roll onward and upward until they
kiss the shores of a land that is fairest of all ?

God bless the doctor who abides in every community to
bless his fellow-men, and who illustrates in his life and char-
acter the splendid sentiment contained in the following
lines :

" There are hermit souls that Hve withdrawn

In the palace of their self-content ;
Their ace souls, like stars, that dwell apart

In flowerless firmament ;
There are pioneer souls that blaze their paths

Where Highways never ran ;
But let me live by the side of the road.

And be the friend of man.

Let me live in a house, by the side of the road,

Where the throngs of men pass by :
The men who are good, and the men who are bad —

As good and as bad as I.
I would not sit in the scorner's seat.

Nor hurl the cynic's band ;
Just let me sit by the side of the road

And be the friend of man.

I see from my home, by the side of the road,

By the side of the highway of life,
The men who press with the ardor of hope,

And the men who faint in the strife.
I turn not away from their smiles or tears —

Both parts of an infinite plan ;
But the doctor lives by the side of the road,

And is the friend of man."

(Applause.)

Mr. President and gentlemen, in conclusion permit me to

say that I read a story of a banquet where numberless yarns

were spun and countless jokes were told, until at last the

banqueters arose and clinked their glasses together and sang

in a chorus :

" Landlord, fill the flowing bowl ;
Fill it till it is running over;
For to-night we will merry be.
And to-morrow we will be sober."

N. C. MEDICAL, SOCIETY.

Then one of the banqueters responded to the toast in this
^vise : "Here's to my country ! Grandest, bravest, freest of
the free! Bounded on the north by the Great Lakes;
boimded on the south by the Gulf of Mexico ; bounded on the
east by the Atlantic Ocean ; bounded on the west by the Pa-
cific Ocean."

Another gentleman arose and said: "Here's to my coun-
try ! Bounded on the north by the :N'orth Pole ; bounded on
the south by the South Pole ; bounded on the east by the rising
sun ; bounded on the west by the setting sun."

But, as champagne went down, patriotism went up, which
culminated in this sentiment:

"Here's to my country! Bounded on the north by the
Aurora Borealis ; bounded on the south by primordial chaos ;
bounded on the east by the precession of the equinoxes;
bounded on the west by the day of Judgment." (Laughter
and applause.)

Mr. President and gentlemen, if I were permitted to carry
out that idea and "bind" the doctor, I would say that he is
"bounded on the north by sympathy; boimded on the south
by service ; bounded on the east by sacrifice ; and bounded on
the west by unswerving devotion to duty. (Applause.)

Beautiful, beautiful mission in life ; fragi-ant as the violet's
perfume; hushed and holy as the Sabbath morning. Xo
artist can paint it ; no sculptor can chisel it ; no tongiie define
its future bounds, challenge its right to live, or question its
humanitarian spirit.

As the Mayor of Winston, Mr. President and gentlemen, I
turn over the keys of the city to you, and offer you special
privileges without your having to incur the penalty for the
violation of any law. (Applause.)

I will ask all of our splendid resident physicians to physic
you, if you get sick ; I will ask all of our distinguished at-
torneys to plead for you, if you get into trouble ; I will in-
struct our efficient chief of police to conduct you to a place

46 FIFTY-FIFTH ANNUAL SESSION

of safety (great applause) if any of you get lost in your per-
ambulations through the mazes of our city.

The only law, gentlemen, you will be required to observe
wall be the law of hospitality, which will forbid you to hasten
away.

In the name of our aspiring city, with its elegant homes
and great manufacturing interests, we open wide our gates
to receive you and bid you a most hearty welcome. (Ap-
plause. )

N. C. MEDICAL SOCIETY. 47

RESPONSE TO THE ADDRESS OF WELCOME

By Dr. C. L. Pridgen, Kinston, N. C.

Mr. President, Ladies and Gentlemen:

I deem it a great honor indeed that I have been chosen to
express to tou to-dav the thanks of this great body for jour
most cordial welcome. Among so many of my old friends —
old both in years and in wisdom — I feel that I am but a boy,
and that it is expected of me to display that enthusiasm
which one practices in returning to you our thanks on this
occasion.

It gives me a peculiar pleasure, Mr. Chairman, to return
our thanks to the people of this good city. Here this morning
I have met so many of my old schoolmates, and particu-
larly my old roommate and schoolmate — a resident of this
city — ^^vhom I have not seen since we sat at the feet of Keen,
DaCosta, Hare and Turner and pleaded with you, Mr. Presi-
dent, for our licenses at Durham.

I have often wished to visit Winston-Salem because of
what I have been told concerning its history: how in the old
days of 1766, when all this part of our State was but a vast
wilderness, a little band of travelers came down from a dis-
tant State, settled here and began to cultivate and develop
it. Laboring against ignorance, want and a lack of utilities,
they persevered until they have made this section of the
State to blossom as the rose, and they have made their influ-
ence felt from border to border of this grand old common-
wealth of ours.

Among this little band called "Moravians" came the
teacher, the carpenter, the farmer, the minister; and last,
but not least, the good old family doctor. He was not the
doctor that you see in your cities to-day. He was far diifer-
ent. jSTo carriage and pair stood prancing at his door to speed
him over the country. jSTo hideously painted and ill-smellino'

48 FIFTY-FIFTH ANNUAL SESSION

motor car awaited his command to speed him over well-
prepared roads on a mission of pleasure ; but on bis tired little
nag or in bis one-borse sbay, and in garments of their own
making, we are told in history, that he answered every call
far and near and carried succor to the unfortunates in bis
own careful and humble way.

Our great convention to-day remembers him with pride
for his struggles in our profession. And nearly one hun-
dred and fifty years later we are assembled here to-day, in all
our strength, where he pursued his lonely labors, to carry
out his safe precepts and to devise ways and means for doing
the greatest good to those of our race who are afflicted with
the greatest affliction that God has put upon mankind — the
loss of health and vigor of mind and body.

It should be an inspiration to us in our Avork this week
when we think of this good old man who labored, wept and
died, unhonored and unsung, here in this place, hallowed by
his memory ; who was ever ready to minister to the wants of
those who needed his assistance, and who struggled to lay the
foundations of that body, whose delegates to this great Con-
vention to-day are met to devise ways and means of carrying
our work onward and upward to perfection.

At the time of which I speak this part of the State was
nothing but a vast wilderness ; but how do w^e see it now ?
After the Revolution the little band of Moravians, who had
settled and prospered and established themselves in their
little village of Salem, sold a part of their lands to other set-
tlers, who formed another town and named it after their
hero of the great Eevolution, Maj. Joseph Winston.

These two little towns were over a mile apart, but they
have now so progressed and groAvn that they have become
one city, with a population of some twenty-five or thirty
thousand people. Here we behold a city with modern sewage
and drainage, wdth a modern water supply, and a city with
handsome and well-appointed hotels, which are not only com-

]Sr. C. MEDICAL, SOCIETY. 49

fortable, Mr. Chairman, but as inexpensive as the luxurious
ones at our State Capital. (Applause.)

Here old Salem Academy is still educating our young
ladies. The time-honored institution that has educated and
graduated over ten thousand girls, from every State and
Territory of our Union, and which is the oldest and most hon-
ored institution of learning in our great commonwealth.

Here we see paved streets, electric lights, street railway
systems, banks with deposits, I am told, of over five million
dollars, manufactures of every description, and everything
that bespeaks the up-to-date, modern city.

We are glad to be welcomed here to-day, to enjoy the well-
known hospitality of a people who advertise to all the world
that we are welcome, and who extend a cordial hand to the
stranger.

We hope to enjoy the balmy air from the hills and to drink
of the pure waters, so abundant, and of other things not so
abundant; we hope to partake of the repast that awaits us,
ever keeping in our minds the cool, clean wards of the new
fifty thousand-dollar hospital, in case we should find ourselves
victims of our own bad juclg-ment.

I thank you, not only individually, for your hearty wel-
come, but I am commissioned by the great Medical Fraternity
of the State of ISTorth Carolina to extend to you their sin-
cere thanks for this kindness.

I will not keep you longer from the pleasures that await
us, and I ask to leave but this one thought with you: We
thank you. (Applause.)

MINUTES

OF THE

FIFTY-FIFTH ANNUAL SESSION

OF THE

Medical Society of tlie State of Nortli Carolina

HELD AT

Winston-Salem, N. C, June 16-18, 1908.

Winston-Salem, K C, Jmie 16, 1908.
At the conclusion of the response to the address of welcome,
Dr. J. Howell Way, of Waynesville, the President-elect,
was introduced by Dr. Spencer and delivered the Presi-
dent's Annual Address, entitled "Random JSTotes on the His-
tory, Aims and Purposes of the Medical Society of the State
of North Carolina." The address was listened to with great
interest and the President was warmly congratulated by many
members on its conclusion. (See Index for address.)

The President called for papers in the Section on Anatomy
and Surgery, Dr. Joshua Tayloe, Chairman.

''Diagnostic Value of Exploratory Incisions With Case
Cited," Dr. Joshua Tayloe, Washington, X. C.

''Ligation of the Femoral Artery Eight Hours After In-
jury ; Results," Dr. J. R. Paddison, Oak Ridge, X. C

DISCUSSION.

Dr. J. M. Paerott, Kinston, K C. : Mr. President: I
am constitutionally opposed to papers being read and not
being discussed.

ISTow that paper possesses unusual genuine merit, and it
is unjust to the Society and to the reader of the paper to
permit it to pass without some remarks.

The only criticism I have to offer about that paper is that
it could not be heard. I believe that if the doctor had read

ISr. C. MEDICAL SOCIETY. 51

the paper with more force, so that those of us who were sit-
ting even near the front could have heard more of it, then
we would have heen very highly edified by the paper.

As it is, I desire to say that I consider it a paper of worth
and character. Such injuries as the doctor has narrated are
liable to fall into the hands of any general practitioner in
ISTorth Carolina, and his way of handling the case certainly
appears practical to me.

It is of great value to a doctor to be prepared at all times
to meet an emergency, under all circumstances, and I desire
to congratulate the doctor upon the nice way in which he
met the emergency in the case, and on the splendid prepara-
tion of that paper.

Dr. a. a. Kext^ Lenoir: J/r. President: I just wish,
sir, to give emphasis to the remarks of Dr. Parrott in regard
to members not raising their voices and reading a paper so
that it can be heard. As you know, I sat near to where the
gentleman stood and I couldn't hear that paper, however good
it may have been, and I know the gentlemen further back
could not understand and fully appreciate the paper.

I know how much time and trouble it takes a doctor to
prepare a paper, and I know when he reads a paper he de-
sires that paper to be heard, and I wish to insist, for my part,
that papers be read so that they can be heard. I enjoy
them and want to hear them.

DISCUSSION.

Dk. J. P. TuRXEE, Greensboro: In regard to this case
of Dr. Paddison's, it is indeed a unique one; and, as Dr.
Parrott has just said, it is a case that may occur in the
practice of any physician. It may occur in the practice of
the man who is ten miles from consulttition, and by reason of
that it is very interesting, or should be, to the general prac-
titioner.

I wish to congratulate Dr. Paddison and Dr. Bahnson on
their good results in this case. And incidentally I would

52 FIFTY-riFTH ANNUAL SESSION

like, right along this line, to report a case that fell into my
hands about two months ago of somewhat similar character.
Dr. Z. T. Brooks, of our town, was called to a young man
who had been shot. He said he shot himself. However that
may be he was shot. The ball had entered his right thigh,
near the hip, and had gone diagonally downward toward the
inner side of the limb and come out, and was lodged im-
mediately under the skin on the inner side of the knee. The
injury had taken place some two hours previous to the doctor
seeing it, and he at once was afraid that the femoral artery
had been injured, and after we had both examined it we were
still afraid that the femoral artery had been injured; but
still, for fear that it had been injured, we did not go into it
at that time, but had the patient sent to the hospital where
he could have good care and be watched closely, and in order
that we might go into it in case of emergency.

There was no hemorrhage of external wound at all, other
than what is to be expected of a pistol ball going through the
skin. In the course of forty-eight hours there was a great
deal of swelling about this leg, and, although the patient was
instructed not to get up at all, to use that leg, he got up, and
when he got up he had a hemorrhage, and as soon as we could
get him in shape we found the femoral artery was cut diag-
onally across in Hunter's canal. We ligated both ends and
our patient got along well. We treated it as an open wound,
in this case, because there was so much clot in the tissues.

The pulse remained good throughout the anesthetic and
afterwards, and never was weak at any time. The only com-
plaint he made of the limb was a certain amount of swelling
that occurred during the next four days and a numbness.

I was very much amused at some of my friends who asked
me, after they found out I had ligated the femoral artery
at the upper end of Hunter's canal — they said : "Well, when
are you going to cut that leg off ?" I said : "Never, as long
as it is warm."

You have a chance to save it, and I make a plea for the

]S\ C. MEDICAL SOCIETY. Oo

trial to save tliese cases. It is worthy of the trial, as Dr. Pad-
dison has demonstrated in his ease, and his case is much
higher up than the one that I had.

Dpw Paddisox closes: Mr. President: I wish to thank
Dr. Turner and Dr. Parrott for the remarks they have made
about cases of this kind.

Dr. Turner brought out one of the points that I consider
in this case of great importance : the question, when we were
in doubt as to Avhat vessel was severed, whether we should go
right into the wound or let it remain as it is, since the
patient is doing well.

In the case of my patient, we took no chances and went
right into the wound, and it was good that we did, I think.

In the case of Dr. Turner's, the question of opening the
thigh was deferred a little while, and the patient upon exer-
cise, or motion of the limb, produced a right considerable
hemorrhage ; and that is a point I am glad he brought out.
It was one that I wondered about in my own mind, and these
cases, of course, coming once in a lifetime to a general prac-
titioner, causes him to wonder what is the best course to
pursue.

I believe that we did the proper thing with this patient in
question.

I thank the gentlemen for their remarks.

'^Orthopedic Surgery, a Plea for the Crippled and De-
formed Children of Xorth Carolina," by Dr. J. L. Haines,
Winston-Salem, X. C.

Dr. W. p. Whittixgtox, of Asheville, K. C. : Mr. Presi-
dent: I thank Dr. Haines very heartily for his short but
very excellent paper.

I think this line of surgery is one that has been very
marvelously neglected, especially in our rural districts. We
find every day, almost, as we go from place to place over the
country children and growTi people — especially grown people,

54 FIFTY-FIFTH ANISTUAL SESSION

I might saj — who are left cripples for life simply because
they did not have the proper advice and care from the family
physician, and at the proper time.

As an illnstration of this fact I call to memory a case of
tallapes eqninis, which I saw a little over a year ago, in a
little girl nine years old. She was literally walking on top
of her foot. I accidentally saw this case, having been called
in consultation to see her father, who was suffering from
pneumonia.

I asked them why they had let the little girl grow up in
that condition. They said the doctor told them it could not
be remedied. The doctor was a graduate in medicine and a
licentiate in North Carolina.

ISTow, I do not mean to criticize, but I mean to encourage
the physicians here to be more careful ; first, in the investiga-
tion of the cause and remedies of some cases, and secondly,
in carrying out the treatment.

I advised these people that with the proper operation and
with the proper brace that foot could be straightened and
made a useful member, and this girl could be made to walk
uprightly and wear a neat, nice shoe. Tliey accepted my
advice, and this girl is now wearing a shoe almost as neat as
the other, and is walking on the bottom of her foot instead
of on the top.

There are some difficulties in carrying out the treatment
of these cases: we often fail to get the cooperation of the
parents, even after we have instituted the treatment.

I remember another case of a little child born with the
tallapes equinis. They asked me what they could do. I told
them it could be cured ; the remedy was easy, but it would
require patience and perseverance. I divided the tendo-
achilis, used the Lorenz method in producing over-correction
of the deformity in the body of the foot ; did not cut the
planter-fascia, as T should have done, and as it is generally
advisable to do, but put the foot in plaster of paris and in
good condition ; kept it in plaster of paris from three to six

]Sr. C. MEDICAL SOCIETY. 55

weeks, applied a brace, aud impressed upon the parents the
importance of keeping the brace on until the child had got-
ten well. The child complained of the brace, the parents took
it off and threw it away, and the child relapsed into the
former condition, but not so extensive.

I did not see the father for quite a w^hile, but I met him
on the street one day. He had the child in the carriage —
the child was about two years old — and I asked him how he
was doing. He said "H^o good,'' and he showed me the child,
with a soft shoe on, his foot almost ready to turn over again.
I said, ''My dear sir, you are neglecting that foot. You are
not following my advice. Come up and let me see the child
and we will adjust the brace, and joii must keep it on."

I know the foot could have been kept in place if they had
just kept the brace on. The parents did not appreciate the
manner in which I gave this advice, and the next thing I heard
they had carried the child to a city in a distant State and
had had the child operated on again. So you see I did not
do my duty in that case, exactly, and the parent did not do
his ; the doctor lost reputation, the parent was put to more
expense than necessary, and the child to probably more muti-
lation and suffering.

To this is one important thing: we must impress on the
minds of the parents of these little fellows the importance of
carrying out the treatment.

All of these tillapes cases can be corrected without exten-
sive and serious operation if the foot is kept in a brace for a
reasonable length of time.

Dk. Haines closes: Mr. President and Gentlemen: Just
one word in conclusion. Those cases, if the family phy-
sician does not get hold of them and seem to take an interest
in them, fall into the hands of quacks. They take these chil-
dren to the brace-fitters, and they more often make the child
fit the brace than the brace fit the child.

They come back home and the child is still deformed. The

56 FIFTY-FIFTH ANNUAL SESSION

family physician should take an interest in those children
and be patient in the treatment of them. It requires a long
experience of time in some cases to correct these deformities.

I had the pleasure of seeing Dr. Lonrenz operate for liis
famous bloodless operation for hip-joint disease, and the re-
sults are mai^velous ; but those children are left in plaster of
paris casts for months and months, and they are closely
watched and treated in the special hospital.

I think if the societies would take more interest in it and
have in every hospital — every town now has a hospital — a
ward specially fitted and adapted for treating these cases, we
could keep more of them in the State and straighten out
more children who would otherwise be badly deformed.

"Some Practical Thoughts on Hernia," read by Dr. R. L.
Payne, of Norfolk, Va.

DISCUSSION.

De. Stuart McGuire : In availing myself of the privi-
leges of the floor, I desire to thank the Society for the invi-
tation to be present at this meeting. I see so many of my
friends that I do not feel at all a stranger and am glad to be
here.

I think the Society is to be congratulated on the admirable
paper of Dr. Payne. He has presented the important sub-
ject of hernia in a clear and practical manner. I thoroughly
agree with him in the advice he gives in dealing with strangu-
lated hernia, namely, that taxis ought to be used with cau-
tion and only during the early stage. That it is the duty of
every practitioner to operate on these cases if a more ex-
perienced surgeon is not quickly available. The work can be
done with a pocket case of instruments, and general anes-
thesia is not necessary as the parts can be rendered insensible
by the injection of a weak solution of cocaine.

I also endorse Dr. Payne's advice with reference to the
treatment of the loop of bowel which is black and may be

N. C. MEDICAL SOCIETY. 57

gangrenous. When in doubt, it should be drawn out of the
abdominal ring, wrapped in gauze and kept wet with hot sa-
line solution. In a few hours either circulation ^^dll retuni
and it can safely be put back in the abdominal cavity, or else
the evidence of gangrene will be unmistakable and the part
can be resected or the patient transported to a hospital, if
the facilities at hand are not adequate to meet the conditions.

I am glad Dr. Payne has sho^Mi me his kitchen strainer.
I have employed, for a similar purpose, artificial wire bust-
forms, which can be purchased in a dry goods store at a nomi-
nal cost. It is sometimes embarrassing, however, to ask a
lady clerk for them, and in future I will get a kitchen strainer
from the five and ten cent store.

As Dr. Payne has said in his paper, hernias ought to be
corrected before they get strangulated. An ounce of preven-
tion is worth a pound of cure.

Hernia is one of the most frequent disabilities that afflict
mankind, and operations have been done for the relief of the
condition as far back as there is any record of surgical work.
One thousand years ago surgeons finding that it was impos-
sible to constrict the abdominal ring, undertook to cure the
trouble by obliterating the abdominal ring. This necessi-
tated castration and so popular did the operation become that
finally laws had to l>e passed in order to regTilate it.

The modern operation for hernia began with the study of
the anatomy of the parts by Cooper. It was made safe by
the establishment of aseptic and antiseptic surgery by Lister.
It was advanced by the introduction of the absorbable suture
by Marcy, and its technique was perfected by the Italian
surgeon Bassini. The latest advance was in demonstrating
that the work could be done safely and painlessly under co-
caine anesthesia by Bodine, of Xew York. "We can now tell
a man who comes to us with hernia that it can be cured
without appreciable danger ; without much question of per-
manencv : without more than two or three Aveeks detention

58 FIFTY-FIFTH ANNUAL SESSION

from business ; Tvithoiit a general anesthetic and withont pain.
If I were beginning surgery and looking for a profitable
field of useful work I would select hernia as the specialty.
From one-eighth to one-sixteenth of the world's population
have the trouble, and here in this town of Winston-Salem I
know there must be one thousand cases which need opera-
tion. There is no field I know of so profitable and none for
which so much good can be done for humanity as in the cure
of hernia. It is the surgeon's duty to educate the practitioner
and the practitioner's duty to educate the laity. A patient
should not be permitted to go through life burdened w^ith a
truss and in constant danger of strangulation, but should
select a convenient time to have his hernia operated on and
cured.

Dr. Weaver^ of Asheville: J/r. President: I am sorry
that the majority of this Society prefers to enjoy the "mess
of pottage" more than this excellent feast, prepared by this
excellent paper of Dr. Pajnae's.

I wish to speak, more from the point of the general prac-
titioner, in reference to the method of treatment of hernia in
children.

I have had on several occasions splendid results in the
treatment by the hank of yarn (in children), and I can say
from experience that it is practical and simple in its method
of application and results, and I would call the attention of
the general practitioner to this simple and practical method
of treatment of hernia in children.

Dk. M. Bolton^ Kich Square, JS". C. : Mr. President:
The gentlemen who have spoken on the subject have stated
that the general practitioner ought to be prepared to do this
operation, and I just want to say that the country practitioner
can do this operation successfully if he will just have the
confidence in himself.

Possibly it has been my lot to see more than my share of
hernia. I have seen one woman die for want of an opera-

N. C. MEDICAL SOCIETY. 59

tion in strangulated hernia. I have seen a man die for posi-
tively refusing to be operated upon for strangulated hernia.

I remember seeing another case, where operation was ad-
vised, refused, and later a surgeon was sent for from the
city and came out and operated after it was too late to save
the patient.

I had a surgeon come into my community and perform
the operation successfully for strangulated hernia on a man
past sixty-five years of age.

I practice in the country and no hospital is accessible. Of
course I can send my patients to Norfolk or Tarboro, but
very often it would take twenty-four hours time for that pa-
tient to reach the hospital, so I determined if I ran up with
another case of strangulated hernia, if the patient would con-
sent, I would take my chances on it. Since that time, with
the assistance of one or two of the neighboring physicians,
I have done this operation for hernia twice, successfully.
The patients have recovered without the least bad symptom.

I have a patient convalescing now from an operation for
incarcerated hernia, with firm adhesions.

The first operation I performed was not difficult, but the
last one I did — two or three weeks ago — I found extremely
difficult. Then I had no experienced anesthetizer, and when
I was about half-way through the operation he told me the
patient's pulse was getting bad (and I know mine was bad,
for I was already in trouble), and he told me to hurry up,
because the patient's pulse was sinking, and I hurried up.

I was not satisfied about the operation, for I feared I had
pushed the intestine back before the adhesions were thor-
oughly broken up. The patient was a negro; he never had a
bad symptom, his temperature never went above one hundred,
and evidently in my fright I had relieved the constriction
thoroughly.

I could not afford to send that man to the hospital after
undertaking the operation and let a surgeon get hold of him,

60 FIFTY-FIFTH AXNUAL SESSION

and I was loath to go back into the abdominal cavity, though
I should have done so, if necessary; but fortunately, as I
said, the case turned out all right.

If the jDhysicians in the country districts are friendly and
are not nervous, and we will study well our limitations and
not go into any of these cases in a reckless manner, we can
do a great many of these things successfully. Several opera-
tions for stone in bladder, abdominal abscess, appendicitis,
etc, have been performed in my section successfully.

The thing for us to observe in the country is absolute
cleanliness. We hear much talk of antisepsis and asepsis
and things of that kind in the cities, but the country prac-
titioner often feels that he has not the microbes to contend
with, and we do not always thoroughly sterilize things as we
should. If we will exercise good horse sense, and have abso-
lute cleanliness, we will have good results.

ITow, a word in regard to the treatment of hernia in very
small children: Dr. Payne refers to a method that is suc-
cessful in his hands. I had a case a few years ago. It was
the child of a merchant. I ordered two or three different
trusses, but none of them fitted; they all irritated the child.
The man's wife was an intelligent Avoman, and we made a
truss. We got some elastic and she tacked on the end of that
elastic a good, soft pad, one big enough to cover the open-
ing, carried it around the child's body and pinned it over the
pad, then carried the end of the band through the perineum
and pinned it posteriorly. She made, possibly, one-half
dozen of those trusses. I always told her to have the child's
hips elevated when she applied the truss, and to be very care-
ful not to allow any protrusion.

That child got well, and since that time I have used a
homemade truss with much more satisfactory results than
with a bought one.

With an intelligent woman to keep the child clean and
use absorbent cotton and things of that kind, where the band

X. C. MEDICAL SOCIETY. 61

has a tendency to irritate the patient, those cases can be
cured.

I have never seen the method Dr. Payne recommends tried.

De. Payxe closes: Mr. President: It is too near din-
ner time to inflict myself further upon this Society, and I
therefore ask that I be excused.

The President announced a recess until 3 p. m.

Tuesday Aftekxoox.

Session resumed at 3 p. m. President Way in the chair.

"Mesenteric Thrombus Pollowing Splenoctomy," Dr. J. W.
Long, Greensboro, X. C. (See index.)

DISCTJSSIOISr.

De. W. S. Eaxkix, Wake Forest, X. C. : The report of
a rare disease is of great importance, because it tends to widen
our clinical horizon and calls attention to diseases that
would otherwise go unrecognized. In this respect the report
of Dr. Long, in regard to this interesting case, is one of the
rarest that has fallen to my limited observation.

What I shall say will be only a general and preliminary
report of a condition which deserves and will receive careful
and thorough treatment later, when time permits.

I wish to-day to call attention to the combination of rare
pathological pictures here present.

First, we have an undoubted case of primary splenomegaby ;
second, a mesenteric thrombus; third, embolic processes,
going on before and after the removal of the spleen, and very
probably a paradoxical embolus, although I am not willing
at this time to be put on record as claiming this last con-
dition to be present.

I received the tissues after they had been in 4 per cent
formalin two or three days, and the following brief descrip-
tion is based on the "fixed" tissues:

62 FIFTY-FIFTH ANNUAL SESSION

SPLEEN.

Size — 15x9 cm.

Weight — 650 grms. jSTormal weight, 170 grms.

Shape — Increase in size takes place in all directions. It
forms an elongated oral, with deep notch on either side.

Capsule — Smooth over most of surface, but here and there
shows numerous connective tissue bands resulting from re-
cent adhesions.

At one place spoors raised, white infarct. Infarct comes
to an apex which looks toward the hilum and measures ap-
proximately 5x3x1 1-2 cm.

Color — Dark.

Consistency — Is in formalin, but even then seems unusually
firm to touch and knife.

Cut surface — Smooth, dark, and in one pole shows numer-
ous punctuate hemorrhages. These are about the infarct.

There is also scattered uniformly over the surface dark
blue spots, round, and measuring 1-7 mm. in diameter.

Microscopic examination shows the condition described
by Boraird and others, to wit: Hyaline degeneration of many
corpuscles, general increase in the reticulum about the sin-
uses, with a swelling of their endothelial lining until some
sinuses are almost filled by it. The hyaline corpuscles cor-
respond with the round, bluish spots described in the gross
specimen.

The symptoms of this disease, as set forth by Dr. Osier,
are: (1) Chronic course, ranging from two to ten years;
(2) enlarged spleen; (3) hematemesis, and (1) a secondary
anemia with a chlorotic tendency.

INTESTINE.

Three pieces of small intestine, measuring altogether
about 120 cm. Of this about 35 cm. is black, hemorrhagic
and gangrenous, fading by gradations into the lighter col-
ored part. The whole intestine is contracted and empty.

K". C. MEDICAL SOCIETY. 63

MESENTERY.

Thickened, contains numerous hard nodules which prove
on section to be thrombi. All mesenteric veins greatly dis-
tended and thrombosed, mesenteric arteries contracted and
empty.

Even in mucosa and sub-mucosa of intestine the dilated
veins can plainly be seen. Mesenteric glands swollen and
deep pink color. All through mesenteric fat we can see trans-
lucent areas and streaks.

Microscopic examination shows the dark area of intestine
to be necrotic and infiltrated with degenerated blood. This
is a hemorrhagic infarction of intestine.

The mesenteric veins under the microscope show an organ-
izing thrombus, which, from its advancement, seems to be
about ten or twelve days old. Some of the veins entering
spleen show a pronounced phlebo-sclercsis. The arteries are
very much contracted and empty, suggesting an occlusion in
them, for if there Avas no influence to close and empty the
arteries the blocking of the veins into which they empty their
contents should have distended them.

The mesenteric glands are swollen and hypersemic, sin-
uses are dilated and there seems to be some proliferation of
the endothelium lining the sinuses.

The translucent areas and streaks noted on gross exami-
nation prove under the microscope to be embryonic connec-
tive tissue.

It is interesting to attempt to connect the pathological
with the clinical picture.

Of course the patient came to Dr. Long with primary
splenomegaby. The spleen was removed and presents the
first puzzle in the anemic infaret ol recent date. i^To clinical
evidence of heart lesion. Whence the infarct producing
embolus ?

Six days after operation the pain in the seat of the w^ound
has reached such intensity as to necessitate reopening. Here

64 FIFTY-FIFTH AX2^UAL SESSION

a lot of clear red-tinged serum has collected. aSTo evidence
of inflammation. This was most certainly the result of ligat-
ing.the numerous large veins that are always associated with
a splenomegaby. The pressure from the accumulated serum
causing the pain, and its removal through the incision and
gauze-drain gave the relief that lasted five or eight days.

After this relief we have a second onset of pain, but situ-
ated more in the umbilical and supra-pubic region, gradual in
onset, but increasing steadily, colicy in nature, later asso-
ciated with more or less intestinal paralysis. In ten or twelve
days this pain reaches a degree no longer bearable, and other
symptoms, too, sigTial the operator. An operation shows the
condition above described. The symptoms correspond to the
formation of the mesenteric thrombus.

But why should the arteries be empty and contracted ?
Could there have been a paradoxical embolus with its origin
in the thrombus and its termination in the mesenteric artery ?

These and others are interesting questions which this
case propounds.

In a fuller report, when we have had more time for a re-
view of the literature, we hope to consider these unsolved
problems of this case.

"The Surgical Conscience," Dr. John C. Rodman, Wash-
ington, X. C.

DISCUSSION.

Dr. Francis Duffy, Xew Bern: 2Ir. President: I am
not willing to let this paper go by without comment, 1
think it very important that this idea of the ''^surgical con-
science," as he calls it, should be always with us. Hospital
appointments, trained nurses, and all that, make it so easy
to operate that you are resisting a temptation, sometimes, and
that idea of "the surgical conscience" has to be kept well
to the front.

If I may be pardoned for personal reference, the doctor

]Sr. C. MEDICAL SOCIETT. 65

spoke of tiis connection with the Marine Hospital service. I
happen to have that same appointment in Xew Bern, and I
remember some time ago how I stood in relation to a patient
of that service.

The man had a compound dislocation of his foot, which was
turned to one side, the smaller bones of the leg broken, the
anterior tibia muscle was torn out and hanging at its lower
attachment ; there seemed to be nothing to do but to amputate
that limb. The assistants I had with me advised amputa-
tion. It was a very easy thing to amputate that leg, but I
thought possibly I could save it. By constructing a perfor-
ated tin apparatus, which would allow me to keep up a pretty
constant irrigation and hold the bones in position, I did
save it.

To make the story short, I cut off some of that muscle,
stitched it back, reduced the dislocation, put drainage tubes
through it, and the man stayed as long as the service will
allow a man to stay with us, and then I transferred him tc
another hospital.

He came into my office a few days ago. He had an anky-
losis, of course, and a surgeon in Baltimore had taken out a
piece of bone there. He had a limb very much better than an
artificial limb, and I must say — while again I apologize for
personal reference — that if I had not consulted my surgical
conscience, I should have amputated that limb.

It was so easy to cut that limb off, and would have been
a great deal less trouble than the course pursued. The some-
what mutilated limb he is now walking with is far superior
to any artificial limb that can be secured.

Dr. JoHJiT Hey Williams, Asheville, IST. C. : I should
like to make a few remarks in regard to Dr. Burrus's paper
of this morning, concerning exploratory incisions.

We know that frequently, with all the aid which our knowl-
edge and science has given us, that we are frequently unable

66 FIFTY-FIFTH ANXUAL SESSIO^^

to make the diagnosis of what is going on in the abdominal
cavity. We know that any man who says that lie can make
a positive diagnosis of abdominal or pelvic trouble, without
an exploratory incision, is a fool. (I am quoting Lawson
Tait.) Any man who has had his hands inside the abdomen
knows full well that he never knows what he is going to find
until he gets in there.

We know that exploratory incisions are so very important
that I do not believe a man would treat his surgical con-
science right if he does not go inside the abdomen with an
exploratory incision. It is done in every town and village
in the country, every day. We know that the knowledge of
even the younger men, fresh from the schools, is such that
they are able to go into the abdomen Vi^ith absolute impunity.
Ninety-nine times out of a hundred they can establish the
diagnosis and they can have plenty of time then to refer the
case to a man that they consider competent, and put the pa-
tient in proper hands, which action wall probably save a life.

I do not think the surgical conscience ought to go quite so
far as to debar a competent man from making those explora-
tory incisions — that we would not like to have classed as
operations. I do not consider them operations, myself, and
w'ould not like to have them classed as such. That is the
only point in which I can have any variance with the doctor.

I know full well the value of the suigical conscience, after
years of knowledge — surgical knowledge, and surgical sur-
gery. I have seen limbs saved that are thoroughly useful
limbs to-day, that, at the first blush, the temptation was to
amputate.

As Dr. Duify says, it is so easy, and saves so much trouble.
It is a brilliant thing to do. It is done in a few minute^,
and the patient is off your mind. That is very easy. Bnt
when you have a poor devil that has no money to pay you
from day to day, for several weeks, it is quite a trial to the
surgical conscience. You know, if you take the responsibility

N. C. MEDICAL SOCIETY. 67

of saving tliat limb, it is up to you to do it, no matter what it
costs you, in time or trouble. It is surgical conscience.
(Applause. )

"Etiology, Symptoms, Diagnosis and Treatment of Em-
j)yeinia, with Report of Thoractomy," by Dr. John T. Bur-
rus, High Point, X. C. (See index.)

DISCUSSION.

Dr. Johx C. Rodmax, Washington, X. C. : Mr. Presi-
dent: I did not hear all of the doctor's paper, but right
along that line I want to report a case that I had two or three
months ago. It was a case sent up to me from the lower
part of the county, a case of long standing in that side of the
pleural cavity.

The accumulation of fluid was so extensive that it pushed
the heart from the left side, clear to the right side, and you
could feel the apex beat on the right side.

I made an incision into the pleural cavity, simply, and
must have gotten between one and two gallons of pus.

The patient remained in the hospital several weeks, but
made a complete recovery.

It w^as a very interesting case to me — that it should push
the heart clear over to the right side, and that there should
have been such a great amount of pus.

Dr. James A. Burroughs, Asheville, IST. C. : I have
enjoyed the doctor's paper very much and do not think that
this Society should pass a paper of its merit without a dis-
cussion.

There are several points that are frequently overlooked by
a large number of physicians.

The first point I wish to make is that empyema should
not ordinarily develop. The serum should be removed as
soon as formed. And if there is a reaccumulation, remove
it again in a length of time varying from four to seven days,
as may be required. After seven days, if there is no re-

68 FIFTY-FIFTH ANNUAL SESSION

accumulation, it is safe to say that the pleura is assuming
a normal condition.

The last thing I did before leaving my office was to tap
the right pleura of a tuberculous patient and remove three
pints of serum. And I doubt if this case will need a second
attention in this manner.

This class of cases is seen in my office — I may say —
several times a week.

I simply scrub the point in a vertical line from the axilla
between the seventh and eighth ribs with alcohol — freeze
the same — introduce the troca and canulla — withdraw the
troca — and the fluid Hows out from position and pressure,
as the stream becomes interrupted by respiration.

There is no excuse for empyema, except ignorance, be-
sides an occasional rupture of a cavity into the pleura pul-
monalis, in which case the pus gravitates into the pleura,
instead of being coughed out by the usual route.

\Yhen the pus cases come under my care — and they do fre-
quently— I either introduce a rubber tube at the lowest point
practicable, or, at times, take out a button of rib and simply
keep the cavity washed out with a salt solution. As the pas
subsides, the drainage tube is removed and sterilized gauze,
of considerable length and quantity, is placed into the bottom
of the pleura, with the end of gauze outside kept in position
by a large safety pin, well strapped with adhesive plaster.
an^ the wound properly dressed.

In no circumstances is peroxide used in the pleural cavity
in my practice. And in my opinion peroxide of hydrogen
never should be used in the pleural cavity.

One more point is this, which should always be recognized :
in a case of dry pleurisy, to say nothing of an effusion of
serum or formation of pus, that every case is tubercular
unless produced by trauma, cancer or syphilis. The three
latter causes are apt to produce empyema.

Dr. J. r. McKay, Buie's Creek, N. C. : Mr. President:
There is one point in regard to the irrigation of the pleura.

K". C. MEDICAL SOCIETY. 69

after tlioractomj, which I wish to emphasize. ]\Iy expe-
rience has not been very extensive, but so far as it goes, it is
opposed to irrigation in these cases.

I distinctly recall a case where irrigation wdth hydrogen
peroxide, permanganate potash solution, or even sterile water,
was followed by rigors or chill and rise of temperature. T
think irrigation not only useless, but harmful.

Although our surgical friends may not agi'ee with us, I
believe that the experience of most physicians will bear me
out in saying that resection of the ribs is rarely called for
except in old or neglected cases.

Dk. L. a. Ckowell, Lincolnton: I certainly concur with
the doctor who has just spoken, in regard to irrigation. I
irrigated one case that came very near dying from collapse
w^hile I was irrigating.

I think, if in these cases we would make the opening suffi-
ciently large to admit index finger, and in that way remove
the clotted pus, there would be no necessity for irrigation.

I have pursued this course in the last cases I have had with
success.

De. J. T. BuRRUs clofies: I thank you, gentlemen, very
much for discussing this paper.

I would like to say that if the pus discharges freely, and
is not too thick, then I do not believe an irrigation is well ;
but if the pus is thick and does not discharge freely, my ex-
perience has been that the irrigation causes the pus to flow
more freely — and certainly there could possibly be no in-
jury sustained by introducing an antiseptic solution, under
certain conditions, into the jDleura cavity.

I was unable to hear Dr. Burroughs's remarks, but I take
it for granted that they were all right.

"Hydrocele," Dr. C. E. Moore, Elm City, X. C.

DISCUSSION".

Dr. Stuart McGuire: Mr. President: I will not de-
tain YOU more than three minutes. I shall call the attention

70 riFTY-riFTH ANNUAL SESSION

of the Association to a new operation for hydrocele called
the "bottle method." Until recently, when a surgeon had to
tackle hydrocele, he either tapped it or injected it, or opened
and packed it, or excised the sac. These different methods
have been most admirably described by Dr. Moore. I have
used them all, but I have never felt satisfied with one of them.

Some months ago there was published in the Annals of
Surgery a description of the new operation, which, to my
mind, is so superior to the old ones that it is destined to suc-
ceed them all. I have done this new operation four times in
the last two months and in no case did it take longer than
five minutes and all the patients were able to leave the hos-
pital within a week.

The scrotum is grasped by the hand, so as to make the
skin tight, and an incision is made through the scrotum, the
distended tunica vaginalis shelled out so that it hangs through
the incision as a flask or bottle. A vertical incision is made
at the neck and the fluid allowed to escape. As soon as the
sac is empied the testicle is brought up to the opening and
pulled through it, thus turning the sac inside out. The mass
is then returned to the scrotum and the skin incision sutured.
"No vessel of sufficient size to necessitate ligation is divided
and no suture except in the skin is employed.

Dk. John W. Long, Greensboro, N. C. : Mr. Chairman:
I rise to say that the operation described by Dr. McGuire, as
I understand him, is an excellent one, and in view of the fact
that following the operation for varicocele, hydrocele will de-
velop in about one case in every ten, it is good practice to
invert the sac, turn the testicle out when operating for varico-
cele, just as is done in the operation for hydrocele. I have
followed this method in a number of cases with good results.

Dr. E. C. Moore closes: Mr. President: I have noth-
ing further to say, except to thank the gentleman for the dis-
cussion of my paper, and particularly do I wish to thank Dr.
McGuire for describing the operation with which I was not
familiar.

]\". C. MEDICAL SOCIETY. 71

''The Influence of the Constitutional Condition of the Pa-
tient on the Result of the Operation," Dr. Stuart McGuire.
Richmond, Va.

DISCUSSION.

Dr. Wiiittington: Mr. President: I enjoyed Dr. Mc-
Guire's paper very much indeed, and I arise — not to add any-
thing to the paper — but to simply bear testimony, and I want
to say that what success I have had in surgery has been due
to the thorough examination, both as to diagnosis and to de-
termine the condition of the patient, in reference to the ad-
visability of operating, and further, to the careful prepara-
tion of the patient, so as to put all the physiological condi-
tions in such a state as to most advantageously favor the
operation.

I have enjoyed the paper very much, and I thank the
doctor for the same.

Dk. McGuire : I have nothing more to add. I desire
to thank the Society.

''Carbuncle — Its Etiology, Pathology and Treatment, Par-
ticularly the Latter," read by Dr. Thos. E. Anderson, of
Statesville, X. C.

discussion.

De. Stuart McGuire : I congratulate Dr. Anderson on
the result of his case. I congratulate myself, too, as the
method he followed is the one I teach my students.

I think, without doubt, the best way to deal with car-
buncle is to bodily excise it before it has time to infect
neighboring tissue. If done early, completely and cleanly it
will save the patient time and the danger of septic compli-
cations.

Dr. G. L. Sikes, Salemburg, ]^. C. : Mr. President: . 1
would like to state that six months ago I performed the
same operation, though at a later stage, on an old lady seventy

72 FIFTY-FIFTH ANNUAL SESSION

years old, and it was quite a success, and quite a relief to the
old lady.

De. M. L. Fox, Guilford College, IS^. C. : Mr. Chairman:
Some of us don't like to operate. I remember being at the
Charlotte Medical Society some years ago, and some man read
a paper on "Excision of Carbuncle," or "Surgical Treat-
ment of Carbuncle." That was news to me, but of course it
is not to some others.

I went home with my mind made up that I would try to
operate on the next carbuncle that I struck. So, in a few
days it happened that a fellow came up to my place stating
that he had not had any sleep for three or four days and that
he had a large carbuncle on his neck.

He was a worthless kind of a fellow, and I thought this
a very good time to try this operation. I told him to go
home and dig down into the earth and get some yellow clay
and make a paste and put it on the back of his neck, as thick
as a silver dollar, and when it got dry, to replace it with the
same application. I instructed him to take some salts and
gave him a tonic of iron and quinine, under the constitutional
condition the doctor speaks of. I told him to report to me in
two days, which he did, with the carbuncle all gone, and with
just a little point, discharged, free of matter. The hardness
had melted away and he told me after the first night he had
slept all right and it gave him no more trouble. Since that
time I have used that same application in quite a number of
cases.

As I say, I am a countryman, and not used to surgery, and
do not practice it very much, and in an impecunious patient,
especially, I think the treatment I have outlined very good.

Db. Wood: I take great pleasure in announcing to the
Society that we have with us Dr. C. L. Lavinder, of the
United States Hospital Service, who is stationed in Wilming-
ton, and I move that he be given the ju-ivileges of the floor.

N. C. MEDICAL SOCIETY. Y3

The Society extends an invitation to all visitors to j)artici-
pate in the discussions.

Discussion of Dr. Anderson's paper resumed :

Dr. Weaver : Perhaps there is no field in medicine more
interesting than that of bacteriology.

Our friend, Dr. Anderson, has very succinctly described
the patholog;^' and the etiology of carbuncle. I wish to ask —
more for information — whether any in the audience have
tried the new theory of bacterial vaccination, with the strep-
tococus serum as vaccine in septicoemias, and staphylococcus
serum in carbuncle ?

If that theory is tnie, if the gr<=iat discovery which has
been made in , opsonic medication by Wright, Douglas, and
all the bacteriologists, it has certainly opened a new field for
the treatment of infectious diseases, and, so far as I am
concerned, the next case of carbuncle, or anything of the
kind, I expect to try a preparation of vaccine for the cure
of it.

If you will pardon a personal reference, I myself had an
onychia on one of my phalanges, and I read of Bier's method
of hypersemia. I thought this a good time to try that theory.
I straightway obtained an elastic bandage, encircled the
finger, and in about half an hour I had tremendous pain. I
still continued my treatment, and in two hours more the
disease was conquered, and in twelve hours there was not a
sign of the disease of the finger.

Isow, what happened there, I don't know, but, according
to Bier's theory, there was an auto-inoculation set up in the
system by which the bacteria were destroyed, and stasis hy-
persemia was accomplished and the disease cured.

It is certainly a great field for study and investigation by
the members of our profession, and I would hail the day
when our rising young men, who are taught so thoroughly in
the colleges, in reference to all these diseases, will take up the
study and see if they can not make a practical application of
this theory for the cure of these infectious diseases.

ii FIFTY-FIFTH ANNUAL SESSION

I will ask Dr. McGiiire if he has had any experience with
the treatment with bacterius in infections diseases ?

Dr. McGuire : Dr. Weaver has opened np a big subject
and has displayed so mnch knowledge of it that I feel I
conld more profitably ask him questions than reply to the
one he has asked me.

The opsonic theory to which he alludes is very abstruse
and difficult to understand. I have given it careful study,
and one of my assistants has done some work in practical
application.

As you all know, Metschnikoflf has taught that the leu-
cocytes eat up bacteria. _ It has been found, however, that
certain conditions affect their appetite. Our effort, under
the opsonic theory, is to get something into the system which
will make the leucocyte active and will make the bacteria
attractive ; in otlier words, just as you put butter on bread to
make a child eat it, so you put a little sauce on the bacteria
to make the leucocyte grab it. This is jDractically effected
by inoculating the patient Avith vaccines. I do not think you
can buy them from the drug store, but believe they have to
be made for each case in a laboratory. The bacteriologist
secures from the patient some of the germs with which he is
infected, grows them in a culture-tube and from them makes
the vaccine. It is found on taking the patient's opsonic
index that after inoculation the blood has a positive phase
and a negative phase. If the dose is given at the wrong
phase, it will do harm rather than good. The opsonic theory
promises to do as much for medicine as the germ theory has
done for surgery. At present, however, it is merely in the
experiment stage. It can only be handled by the skillful
bacteriologist, and the general practitioner will have to wait
until methods have been simplified and much that is not yet
understood made plain.

Dr. Anderson closes: Mr. President: I once heard of
a man, a father, who gave an entertainment at his home, and

N. C. MEDICAL SOCIETY. 75

in the course of bis entertainment he announced to the as-
sembled guests that bis daughter would now recite a piece ;
and when he looked around and saw the consternation on the
faces of bis guests, he said : ''Eemember, I give a fine gold
opera glass to every one who stays to bear her."

I am veiw much obliged to the members of this Society
who stayed to hear this paper without any reward.

"Endo-aneurismorrbapby" (Matas), Dr. Thos. M. Green,
Wilmington, K". C.

Dr. C. L. LAvmDER, U. S. P. H. and M. H. S. : As an
officer in the United States Hospital Service, and in accord-
ance with your motion just now^ made, 3'ou gave me the privi-
leges of the floor and accorded me the right to discuss your
papers.

In regard to Dr. Green's paper : I was also personally ac-
quainted with this case, as it came under my care for a while,
and, W'hile I am not a surgeon, I am a general practitioner —
as most of us are.

It seems to me to be an operation that is certainly the
operation, in a great many cases, of aneurism, and it seems
strange to me that the operation has found favor so very
slowly.

Dr. Green has covered the operation very carefully. I
was present at the operation and was struck with its sim-
plicity and the beautiful results which it gave.

Dr. Greex closes: Mr. President and GenUemen: The
only thing I have to say in closing is just to repeat what Dr.
Lavinder says.

At the first blush it does seem odd to go boldly into an
aneurismal sac — wdiich w^e have ahvays treated with so much
respect — but in almost all instances we can control the circu-
lation to the sac, wdiich makes it the simplest operation imag-
inable.

It consists merely of opening the sac and closing one or
more orifices, two or three stitches to each orifice, and then

76 FIFTY-FIFTH AXKUAL SESSION

closing the sac. To do the operation as I did on this man,
would require perhaps fifteen minutes, and we were not mak-
ing fast progress, either. It is just this sunplicity which
commends it to me.

At the same time, it does not interfere with the collateral
circulation, which is absolutely necessary for success.

Tuesday Evening, June 16th.

THE MEMORIAL MEETING.

The President, Dr. Way in the chair : The Society will
please be in order, and the Memorial Meeting will begin.
Dr. C. A. Julian, the Chairman of the Obituary Committee,
will submit the Annual Report.

Dr. Julian: Mr. President and Gentlemen: This is
the report of the Obituary Committee of the ISTorth Carolina
Medical Society: (See report.)

Papers read as follows:

"Memorial Services," report by Dr. Julian.

"In Memoriam, Patrick Livingstone Murphy," Dr. E. II.
Lewis, Raleigh.

"In Memoriam, Patrick Livingstone Murphy," Dr. G. G.
Thomas, Wilmington.

"Life and Works of Dr. P. L. Murphy," Dr. G. M.
Cooper, Clinton, ]^. C.

"Memorial, Dr. P. L. Murphy," Dr. A. W. Knox.

"A Tribute to Dr. Joseph Graham," Dr. H. T. Bahnson.
Winston-Salem, JST. C.

(See index for above jjapers.)

The President: If there are others present who desire
to say anything in regard to the character or the life of any
of our deceased members, we will be pleased to hear them.

Dr. J. H. Marsh: Mr. President and Gentlemen: I
wish that I felt competent to pay some small tribute to the

N. C. MEDICAL, SOCIETY. 77

memory of Dr. T. D. Haigli, of Fayetteville, whose long ser-
vice in the profession, and whose honors the Society always
bestowed upon him, before I became a member of the profes-
sion, and who, in his later life and declining years, in his old
age, was such an example of the pure Christian gentleman
that we of the Cape Fear section delighted to call him the
"Father" of our profession.

Dr. Haigh was of sterling material. He w^as one of the
most honest, upright Christian gentlemen it has ever been
my pleasure to know, and I always delighted to be in his
presence. It was not only so with myself, but in a number
of counties within our section he was the pet of the com-
munity, and in his old age, during his declining health, when
he became too feeble for active practice, it was a pleasure to
meet with him, to call upon him and associate with him in
his latter days.

I wish, as I said before, that I were competent to pay some
just tribute to his memory here to-night. (Applause.)

Dr. Sykes: Mr. President: Will the chair entertain a
motion here to-night in regard to Dr. Murphy's life, and the
Transactions, that I wish to put ?

The President: Yes, sir, with pleasure.

Dr. Syke : As Dr. Murphy was a member of the Sampson
Society, and I am a member of that Society, and represent
it at this meeting, I would like the chair to entertain this
proposition: That a photograph of Dr. Murphy be allowed
to go into the Transactions, along with the minutes of this
meeting.

The Preside:nt : Without objection, that will take the
usual order of such business matters, and be referred, with-
out debate, to the House of Delegates.

Dr. K. G. Averitt : Mr. President : As a member of
the Cumberland Society — Dr. Haigh's old home — I desire
to sav a few words in honor of Dr. Haioh's memory. To

FIFTY-FIFTH ANNUAL SESSION

me he was one of the greatest physicians that I have ever
had the pleasure of knowing. He was a man that was well
posted in his profession, a man that kept up a keen interest
in everything that pertained to the profession, up to the very
day that he had to give up the cares of the world. He was
a man that the general practitioner could always go to and
get something from, when he needed consultation. He was
a man that was sensible. He always looked with condemna-
tion upon everything that even smacked of being wrong. He
was a man that, to me, seemed to live with the supreme idea
ever uppermost in his mind, that the chief end and aim of
man should be to develop into the full likeness of his Maker,
and I do believe that he derived his ideas of life from the
world where he now is — the world where there is no more
sorrow, pain, sickness, or anything to disturb his peaceful
rest.

De. Eose: Mr. President: I am not a speaker, but I
can not let this occasion pass without a word in memory of
my dear medical father, Dr. Haigh. Living next door to
him as I did, he w^as indeed my medical father, and I have
no words to express my feelings, because my heart is over-
flowing with them.

He began the practice of medicine in Eayetteville in the
spring of '51, and practiced fifty-six years, giving up actual
active practice about two years ago. He was a man that
gave his life, his mind and his soul to the practice of medi-
cine. He had no other "iron in the fire," like many of u.^
have. He was a man of strict likes and prejudices, but he
had the highest regard for a man whose opinions showed
thought and who w^as honest in those opinions, but he had
the highest contempt for any one whose opinions or ideas
smacked of dishonesty or insincerity. He was a man that
had served for years as our Count v Society's President. He
never failed to be in attendance at every meeting of our So-
ciety, and it was one of the greatest pleasures of my life to

N. C. MEDICAL SOCIETY. 79

be with him at all times, and he took a great interest in me
as his "medical son," as he called me ; and I, more than any
one else in my own home, where he practiced, of course miss
him more than any one else.

The Peesidext : Is there any one who desires to submit
any further remarks ?

Du. Bex K. Hays: Mr. President: I do not know in
wdiat form to put the desire that I wish to express, but I
should like to take some action by which these most excellent
papers we have heard read this evening may be called to the
attention and published in the press — of course they will ap-
pear in the Transactions ; but I think the leading daily papers
of the State will be most pleased to obtain the four papers
that have been read this evening, and if it is in order I would
like to introduce a resolution that these papers be published
in some of our Sunday papers. I make a motion to that
effect. Motion unanimously carried.

The Peesidext : De. Way : The Secretary will please
make a note of this motion just passed and see that the Sun-
day papers are provided with these beautiful memoria]
tributes.

If there is nothing further, gentlemen, before we take a
recess I desire to make the following announcements:

The State Board of Health will meet immediately after the
close of this session in room 204 at the Zinzendorf Hotel.

The House of Delegates will meet in its hall in the Munici-
pal building in the city hall to-morrow morning at 8 :30 sharp.

The general meeting will come to order in this hall to-
morrow morning at 9 o'clock.

The special order of the election of the Board of Examin-
ers will be in this hall to-morrow morning at 10 o'clock.

The conjoint meeting of the State Board of Health and

80 FIFTY-FIFTH AIv^NUAL SESSION

the State Medical Society will be held to-morrow in this hall
at 12 — noon.

There being nothing further to come before this meeting
this evening, I declare a recess until 9 o'clock to-morrow
mornino-.

Wednesday Morning, June 17, 1908.

The Society was called to order at 9 a. m. by the Vice-
President, Dr. Chas. A. Julian, the President, Dr. Way,
being in attendance upon the session of the House of Dele-
gates.

Dr. E. B. Glenn, of Asheville, presented a paper entitled :
"Enchondromata ; Eeport of Case Undergoing Malignant De-
generation."

This was followed by another paper read by Dr. L. B. Mc-
Brayer, of Asheville, entitled : ''The Importance of the Work
of the General Practitioner."

Dr. Way resumed the occupancy of the President's chair
at 10 a. m.

The President: Dr. Way: Gentlemen: This body
will now proceed, without further ceremony, to discharge the
important duty incumbent upon you once every six years of
selecting the Board of Seven Medical Examiners of this
State.

I will appoint to collect the ballots and make a report of
the same to this body Drs. A. W. Knox, A. J. Crowell, George
G. Thomas and J. E. Stokes.

]*^ominations are now in order, and I would suggest that
nominating speeches be limited to two minutes. The tellers
will, as nominations are made, place the same on the black-
board.

Dr. Joh^- Roy Williams: Mr. President: I rise to
ask a personal privilege.

The President: Dr. Williams.

N. C. MEDICAL SOCIETY. 81

De. Williams: 2Ir. President and Members of the
Society: The Guilford County Medieal Society has selected
me, its President, to come to this Society and introduce a set
of resolutions for its consideration. These resolutions were
adoj^ted by the^ Guilford County Medical Society in Conven-
tion assembled by unanimous vote, and they have requested
me to bring thein here and to present them to our Secretary,
to read to you for your consideration and for your action.

The question of jDcrsonal privilege, may it please the Presi-
dent and gentlemen^ is that the Guilford County Medical
Society is a component part of the Xorth Carolina Medical
Society, and that its individual privileges have been intruded
upon, and that the privileges and rights of the ISTorth Carolina
Medical Society have been called into question, and these
resolutions have to bear on that controversy. When the Sec-
retary shall have read it, I beg the privilege of discussine
these resolutions.

Tpie President : The Chair rules that Dr. Williams has
failed to state a question of personal privilege ; and further,
that a special order is before this Society and, having been
called. Dr. Williams is therefore out of order.

De. Williams: J/r. President: I appeal from the de-
cision of the Chair.

The Peesidext: Those favoring the decision of the
Chair will make it known by rising.

Dr. Booth: Has this anything to do with this special
hour ?

Dr. Williams : This is a question that involves the entire
Xorth Carolina Medical Society.

De. Paeeott: Has it anything to do with the election
of the Board of Medical Examiners ?

De. Williams: Nothing whatever.
6

82 FIFTY-FIFTH ANNUAL SESSION

Dr. Paerott : Then, Mr. President, it is out of order.

The President : It is out of order, and is so ruled out
of order. The question is, that upon sustaining the decision
of the Chair, that Dr. J. Roy Williams is out of order. Those
in favor of sustaining the Chair will make it known by
rising.

Dr. Knox: Mr. President: I can not vote intelligently
unless I know what the question of personal privilege is. One
may have an idea, but if I know what the question is I can
cast an intelligent vote. I want to sustain the Chair, because
we ought to sustain our presiding officer, but I can not vote
intelligently until I know what it is. We ought to let the
Society know exactly what the question of personal privileg*,
is to vote intelligently.

Dr. Williams: Mr. President: If the Secretary will
read this he will see that it is in order.

The President: Gentlemen of the Society: The special
order for this hour was called. Dr. Williams was recognized
by the Chair on a question of personal privilege. As the
Chair understood it that personal privilege was the right to
introduce certain resolutions not related to the special order
before the Society, but the exact purport and nature of which
he did not state. The Chair ruled him out of order, as a
special order had been called. An appeal has been made
from the decision of the Chair. The question is on the sus-
taining of the chair. Those favoring the decision of the
Chair will signify it by rising.

The Secretary: Mr. President: I don't see how I C'Tu
count them, because a great many were standing before the
rising vote was asked for.

The President: Those who propose to sustain the Chaii
will rise. (The vote is taken.)

The President : The Chair is sustained. ISTominations
for the Board of Medical Examiners are now in order.

N. C. MEDICAL SOCIETY. 83

Dk, Duffy: Mr. President: Preliminary to the elec-
tion of the Board of Examiners I think it would be well for
the Secretary to read section 5, under chapter V, on the elec-
tion of officers.

The Pkesibent: The Secretary will please read this
section of the law.

The Secketary: "Any person kno^vn to have solicited
votes for, or sought any office within the gift of this Society.
shall be ineligible for any office for two years." (Laughter
and applause.)

Dk. J. P. Turistek: Mr. President: I rise, sir, to make
a motion : That we have nominating speeches of as short an
order as possible, because, as I understand it, there are a
great many men running for office here this morning; that
we limit the nominating speeches to two minutes, and that we
do not have more than one speech to second each nomination.
Seconded.

The President: It has been moved and seconded that
nominating speeches be limited to two minutes, and that each
nominee be limited to one seconding speech. Those favoring
the adoption of it will signify it by saying aye. Those op-
posed, no. Motion carried.

Dr. p. Duffy : I rise, sir, to name a gentleman from the
eastern section. In selecting our Board we have not only
to consider the fitness of a man for this important office, but
we must also take into consideration a man for geographical
reasons. I desire to nominate Dr. J. L. Nicholson.

Dr. R. H. Lewis : I second the nomination of Dr. ISTich-
olson. He has been most faithful to the interests of the So-
ciety. He is one of the strong men of our profession. Dr.
Nicholson is one of the strongest men in North Carolina. He
is the very best type of country doctor, and I hold that there
is no higher type of the medical profession than a first-class

84 FIFTY-FIFTH ANNUAL SESSION

country doctor. (Applause.) He is gifted not only with
common sense, but with a high character, a man of most ex-
cellent judgment, and would give recognized stability to the
new Board. I heartily second his nomination.

The President : Dr. J. L. Nicholson is placed in nomi-
nation.

Dr. Albert Anderson : Mr. President and Gentlemen
of the North Carolina Medical Society: I rise to place in
nomination a man, in my opinion, well qualified to fill a place
on the Board, a gentleman that I have known for nearly
twenty-five years, nineteen years of which has been in close
touch with his profession. As to the section read by the Sec-
retary he is eminently qualified, for he has never asked for
an ofiice, but he has had offices and honors from the Society.
He was once honored by being your orator. It is with great
pleasure, therefore, that I put in nomination the man who
has been your orator and thrilled you as no other orator evei
was listened to by the North Carolina Medical Society. 1
refer to Dr. E. G. Moore, of Elm City ; a scholar and a
gentleman whom I think the gentlemen will place on this
Board.

The President : Dr. E. G. Moore, of Elm City, is placed
in nomination.

Dr : 3Ir. President: I second the nomination.

Dr. J. P. Monroe: Mr. President: I rise to place in
nomination a man who needs no introduction to the Society.
We don't need handsome men, but he is a handsome man.
He has been in active practice for a number of years. He
has done splendid work in this Society, and I believe he has
never been honored with any conspicuous office. He is r
man who will do honor to this Society and to this section.
And then, another thing: we have plenty of handsome men;
we have plenty of educated men ; but these are not the only
kind we need. We need men of judicial and even tempera-

N. C. MEDICAL SOCIETY. 85

ment who can make and judge men, and weigh the examina-
tion papers as thev should be weighed. I refer to Dr. W. W.
McKenzie, of Salisbury.

The Pkesident: Dr. ^Y. W. McKenzie, of Salisbury, is
placed in nomination.

Dk. C. W. Mosley: Mr. President: I rise to place a
man in nomination who is known to you all ; a man of con-
spicuous literary attainments; a man who will have weight;
he has been a member of the Society for twenty-two years,
and has attended nineteen of the meetings. He is loved in
his community; he is a man conspicuous in his profession.
He is a man not so old that he has lost the fellowship of
younger men, neither is he so young that he is out of place
with the older men. I refer to Dr. H. H. Dodson, of Greens-
boro.

The President: Dr. H. H. Dodson, of Greensboro, is
placed in nomination.

Dr. S. T. I^icholson: Mr. President: I desire to place
in nomination the name of a man who for sixteen long years
has, by his untiring energy, unswerving integrity, indomit-
able will and perseverance, with unceasing devotion and loy-
alty to the Society, demonstrated his fitness to fill this hon-
orable position. He is a man of conscience, of wisdom and
of strength ; he is a man the east is pleased to honor, because
he has never permitted their banner to trail in the dust when
entrusted to him. Honor him, and he will honor this Society
by discharging his conscientious duty to the State of ISTorth
Carolina. I refer to Dr. John C. Eodman, of Washington
K C.

The Presideistt: Dr. John C. Eodman, of Washington.
]^. C, is placed in nomination.

Dr. H. B. Weaver: The people of ^orth Carolina,
through their representatives, the Legislature, have committed
to the Society a trust almost sacred in its relation to the citi-

86 FIFTY-FIFTH ANNUAL SESSION

zenship of North Carolina, and that trust is that this Society
shall elect seven men, who shall hold practically the destinies
of the upbuilding of this Society in their hands. Gentlemen
it takes many primary factors to constitute a man well quali-
fied to fill the place of a medical examiner. In the first place
he should have a sufficient preliminary education; in the
second place he should possess a sufficient number of years o±
experience in the practice of medicine and surgery; and, in
the third place, he should have a moral quality which so emi-
nently befits every man who occupies this important trust.
And, sirs, I believe I can present to you a man from Western
Carolina who represents twenty of those counties, who is in
every way fitted to fill that important office. He is a known
book, read by all men. He is a man who, in every respect,
will fill all the requirements of the Medical Board of Ex-
aminers, and that man is Dr. W. P. Whittington, of Ashe-
ville. He is a man of a judicial turn of mind; he is a con-
servative man; he is a representative man; he is a man we
sent to the Legislature years ago, when our medical law wa&
in jeopardy, and he helped us eliminate an obnoxious princi-
ple in legislation.

In all the States of the Union old North Carolina now
stands and is quoted at the Medical Associations as one of the
top States for medical education, and Dr. Whittington has
been one of the prime factors in bringing this about. I there-
fore ask you to vote for Dr. Whittington, and the people o.t
the western section of the State will thank you for it.

The President : Dr. W. P. Whittington, of Asheville, if
placed in nomination.

Dr. D. a. Stanton: Mr. President and Gentlemen.
There would be no end to the good things that could be said oi
one hundred or two hundred and fifty men in this assembly
to-day as to their fitness for the high places we are going soon
to distribute ; but in the selection of these men the greatest
care should be exercised and the merits of the men should be

:!C. C. MEDICAL SOCIETY. 87

known to the men who are going to vote ; and while it is not
necessary for me to detail the qualities of the man I am going
to name, for twenty-two years he has been as interested in
the Medical Society as any man in it. Only once out of this
twenty-two years has he failed to be present at any of the
sessions of the Society. He has contributed of his time,
money and his ability to forward medical progress in North
Carolina. The man I would like to see elected on this Board
is Dr. C. A. Julian, of Thomasville, IST. C.

The Pkesidext : Dr. Charles A. Julian, of Thomasville,
is placed in nomination.

Dk. a. J. Ceowell: I am not an orator, but since the
man I am going to put in nomination needs no eulogy before
this Society, and the mention of his name only is sufficient, I
put in nomination Dr. Ben K. Hays, of Oxford.

The President : Dr. Ben K. Hays, of Oxford, is placed
in nomination.

Dr. Geo. G. Thomas : I wish to offer for your consider-
ation the name of a man whose only crime is, possibly, com-
parative youth ; but he has judgment, he has firmness, he has
honesty, he has eminent ability, both in his own name and
by inheritance. I refer to Dr. Edward J. "Wood, of Wilming-
ton.

The President : Dr. Edward J. Wood, of Wilmington,
is placed in nomination.

De. H. L. Moxk: It gives me great pleasure, gentlemen,
as President of the Rowan Medical Society, to second the
nomination of Dr. McKenzie, w^ho has always been an ethical
member and is a man of known ability.

Dr. E. T. Dickinsox: J/r. Presideni: I want to second
the nomination and give all the influence I possess to the
furtherance of the nomination of Dr. Chas. A. Julian and Dr.
John C. Rodman.

88 FIFTY-FIFTH ANNUAL SESSION

Dk. S. a. Stevens : I desire to place in nomination the
najne of a man from the Seventh District. We have had no
representative, and onr county was among the first to organ-
ize on the j)lan of the American organization. The man
whom I desire to nominate is eminently qualified in every re-
sj)ect; he is a man of good education, a graduate of the Uni-
versity of IsTorth Carolina, a man of good judgment and, most
important of all, a man who will not throw his book open at
every few pages and put do\vn questions that he could not
answer himself. This has been done in this Society and that
has been done before the Board. The man I refer to is Dr.
J. W. Neal, of Monroe.

The President: Dr. J. W. ISTeal, of Monroe, is placed
in nomination.

Dk. Lockett^ of Winston: Mr. President: I would like
to place in nomination the name of the President of the For-
syth Medical Society, who has the unanimous endorsement
of that Society. I take great pleasure in nominating Dr
John Bynum, of Winston.

The President : Dr. John Bynum, of Winston, is placed
in nomination.

Dr. a. B. Croom : I desire to remind the Society that
there is a section of the State known as the ''Upper Cape
Fear." It has not been represented for more than twent}^
years ; since the days of Dr. Thomas Haigh. It was then
represented by the late lamented Dr. Haigh. We have an-
other Dr. Haigh — Dr. J. H. Marsh — and I therefore take
pleasure in placing his name before the Society.

The President: Dr. J. H. Marsh, of Fayetteville. is
placed in nomination.

Dr. H. H. Harris : It gives me pleasure to second the
name of the gentleman from Wilmington, Dr. E. J. Wood.

Dr. Booth : I wish to second the nomination of a man
who is a born writer and orator. Sometimes the question is

X. c. :medical society. 89

raised whether this Examining Board ought to exist, and il
thej are doing the best for tlie profession in jS^orth Carolina.
We ought to have upon that Board men who of themselves are
capable of defending that Board, and I desire to place such
a man in nomination who is very capable. There is no use
saying more about it, he is fitted for this place. His name
is Dr, L. B. McBrayer, of Asheville.

The Pkesidext : Dr. L. B. McBrayer, of Asheville, is
placed in nomination.

Dr. J. B. Ceaxmer : Xorth Carolina has been fortunate
in the past in having men of intelligence and high character
upon its Board of Medical Examiners. We wish to keep up
that reputation. I therefore place in nomination Dr. Charles
T. Harper, of "Wilmington.

The Peesidext : Dr. Charles T. Harper, of Wilmington
is placed in nomination.

Dr. B. F. Halset: I desire to place in nomination Dr.
Joshua Tayloe.

Dr. J. E. Brooks : Dr. Lewis has said the medical pro-
fession of !N^orth Carolina is higher than that of any other
State in the Union. That is due to the Examining Board.
There have been few cranks turned loose on the community.
They are well balanced and trained to their work, and I wish
to nominate a man this morning who will help to keep up this
high standard, who stands upon the honor roll in the profes-
sion ; a man who is a surgeon, who is equipped for his work,
who is honest, fair and upright in his daily life-work, and
who treats his fellow physicians as he would like to be treated.
I nominate Dr. Thomas E. Little, of Greensboro.

The Pkesidext : Dr. Thomas P. Little, of Greensboro
is placed in nomination,

Dr : Mr. President: I rise to second the nom-
ination of Dr. Whittiiiffton,

90 FIFTY-FIFTH ANNUAL SESSION

De. Jno. T. Burrus : I rise to place in nomination a
young man who has been very loyal to the North Carolina
Society since he became a member. The gentleman to whom
I refer is Dr. John Roy Williams, of Greensboro.

The President : Dr. John Eoy Williams, of Greensboro
is placed in nomination.

Dr. Williams: Mr. President: I wish to thank my
friends for nominating me for this position, and I wish tc
say that I feel keenly the honor, but I must insist that my
friend withdraw my name. I have done but little to uplift
the name of this Society. I feel that I have much yet to do
before I win my spurs, and I wish all who would vote for me
that they will join me in the support of Dr. H. H. Dodson.
of Guilford.

Dr. Burrus: I take pleasure in withdrawing Dr. Wil-
liams's nomination.

Dr. Monroe : I second the nomination of Dr. Harper, ol
Wilmington.

Dr. a. S. Rose : I Avish to place in nomination the name
of Dr. I. M. Taylor, of Morganton.

The President: Dr. I. M. Taylor, of Morganton, is
placed in nomination.

Dr. Sam Stevens : I would like to suggest that we have
some way of putting down in these lists the district to which
they belong There are good men in each district. We wani
to give them a chance, and we do not know, in a good many
cases, what district they belong to. I simply ask for infor-
mation if there is not some way by which we can know tc
which district they belong. Of course we know they live in a
certain place, but we do not know the district.

Dr. E. B. Glenn: I would suggest along that line that
the name of the district be placed after each man's name on
the blackboard — the councilor district.

]Sr. C. MEDICAL SOCIETY. 91

The President: The gentlemen making the roll will sc
list the nominees.

De. Browx : I second the nomination of Dr. Joshua
Tayloe.

Dk. Mc Annally : I move the nominations be closed.

Dr. Lewis : I second the motion.

The President : The motion is that nominations be
closed. It is before you.

Dr. Parrott : I move not to close until everybody gets
nominated. I am in favor of a motion in the way of a gen-
eral amnesty, to nominate every one.

The President: It is moved and seconded that nomina-
tions be closed. Those favoring it say "Aye" ; those opposed
''Xo." The Association voted loudly "ISTo."

The President : The motion is lost. We will proceed
with the nominations.

Dr. Chas. T. Harper : I desire to place in nomination a
man who has taken an active interest in all the affairs of
medicine in ISTorth Carolina, our good, jovial, kind, learned
friend, Dr. Ben F. Halsey, of Roper.

The President: Dr. B. F. Halsey, of Roper, is placed
in nomination.

Dr. J. B. Smith: Mr. President and Members of the
North Carolina Medical Society: I desire to place in nomi-
nation Dr. J. W. Ring, of Wilson.

Nomination seconded.

The President: Dr. J. W. Ring, of Wilson, is placed
in nomination.

The President : Are there further nominations ?

Dr. R. H. Lewis : I make a motion that all below the
highest fourteen be dropped after the first ballot. That makes

92 FIFTY-FIFTH ANNUAL SESSION

a double number to choose from — all below the first four-
teen— the lowest below the first or highest fourteen be dropped
at the first ballot.

Seconded by several.

The President : It is moved and seconded that all be-
low^ the first fourteen be dropped in the second ballot.

Dk. E. B. Glenn : I would like to amend that by saying
all of the fourteen highest to be retained, as they stand, ac-
cording to their vote.

De. Buukoughs: That isn't the old way we did things.
We dropped the lowest.

The Pkesident : It has been moved and seconded that
after the first ballot all below the highest fourteen be dropped
from further consideration. It has been amended that the
fourteen highest be retained. Those favoring the ado])tion
of that amendment will favor it by saying "Aye." Those
opposed "ISTo."

The President : The amendment is carried.
(Cries of ''Question.")

The President : Those favoring the amended motion
will please rise, and remain standing until counted. The
opi^osite vote please rise.

The President : The motion prevails, and after the first
ballot all below the highest fourteen will be dropped from
consideration.

Dr. J. M. Blair: Mr. Chairman: I rise to second the
nomination of Dr. W. W. McKenzie.

The President: The Chair would be pleased to enter-
tain a motion that nominations be now closed.
(The motion was made.)

The President: It has been moved and seconded that
nominations be now closed. Those favoring it say "Aye."
Those opposed "No."

jSr. C. MEDICAL SOCIETY. 93

The nominations are now closed. The Convention then
east its vote.

Dr. Geo. G. Thomas : On behalf of the tellers I beg leave
to announce that 243 votes were cast and five Examiners
elected, wdth the following vote: Drs. J. L. Xicholson, 129 ;
W. W. jMcKenzie, 157; H. H. Dodson, 124; Ben K. Hays
153 ; and L. B. McBrayer, 130. Each having received a ma
jority of the votes cast are elected. (Applause.)

In accordance with the resolutions passed governing this
election only the nine out of the fourteen, as adopted by your-
selves, out of the fourteen highest (five of the fourteen being
elected) can be voted for on the next ballot. Gentlemen, pre-
pare for the next ballot.

Dk. E. B, Glexx : I would like to offer a resolution that
all but the two highest be dropped. Resolution declared out
of order.

Dr. G. G. Thomas : Gentlemen, it has been suggested to
me to again read to you a vote of the successful candidates.
I ^^dll be glad to do so:

J. L. :Nicholson, 129; W. W. McKenzie, 157; H. H. Dod-
son, 124 ; B. K. Hays, 153 ; L. B. McBrayer, 130. 122 neces-
sary to elect.

Dr. John Roy Williams : Inasmuch as it requires con-
siderable time to count these ballots, I Avish to move that the
Society proceed to consider the resolutions sent by me to you
from the Guilford County Medical Society.

Seconded by Dr. Jno. T. Buerus.

The Peesidext : The Chair rules that the special ordei
of election of the Board of Medical Examiners being on
hand, the consideration of resolutions by this Society are out
of order.

Dr. "Williams : In view of the fact that this motion I
have just made will in no sense interfere with the progress of

94: FIFTY-FIFTH ANNUAL SESSION

this election, and in view of the fact that Guilford County
has a perfect right to send to this Society these resolutions.
I appeal from the decision of the Chair.

The President : The decision of the Chair is appealed
from. Those favoring the sustaining of the decision of the
Chair — and that decision is the election of the Board of Ex-
aminers being on hand, until that matter is disposed of nc
further business can be transacted by this Society — that is
the decision of the Chair. As many as favor the sustaining
of the Chair in that decision make it known by saying "Aye.''
Those opposed, "No."

The President: The Chair is sustained.

Dr. Thomas: Gentlemen, the result of the second ballot
is as follows : 206 votes cast. Necessary to elect, 104 ; of
which Dr. John C. Rodman, having received 107, is elected.

In order they stand next:

C. A. Julian, 57 ; J. W. Bynum, 51 ; E. J. Wood, 46 ; J.
H. Marsh, 45 ; J. W. Neal 37 ; C. T. Harper, 36 ; I. M. Tay-
lor, 26. One more man to be elected.

Dr. a. J. Crowell : Mr. President: We are consum-
ing a lot of time, and inasmuch as Dr. Julian has not been
elected in two ballotings, but is leading, I move, sir, that he
be elected, if it is not out of order.

Motion seconded.

Dr. J. L. Haines: Mr. President: I object to that.
We have a man here, Dr. J. W. Bynum, and we would like
to see a fair election.

Dr. J. P. Monroe : I move after the next ballot, in the
event of no election, all except the two highest be dropped.
So ordered.

Dr. G. G. Thomas: Gentlemen: The result of this bal-
lot is : Dr. Julian, 47 ; Dr. Bvnum, 75. Dr. Bynum is
elected.

]Sr. C. MEDICAL SOCIETY. 95

The Pkesidext : The following gentlemen having re-
ceived a majority of the ballots east in this election, are de-
clared elected the Board of Medical Examiners of the State
of Korth Carolina for the term of six years each: ^

Dr. J. L. iSTicholson, of Riehlands.
Dr. W. u'. McKenzie, of Salisbury.
Dr. H. II. Dodson, of Greensboro.
Dr. Ben K. Hays, of Oxford,
Dr. L. B. McBrayer, of Asheville.
Dr. John C. Rodman, of Washington.
Dr. John Byniim, of Winston.

These gentlemen will meet at such hour as may suit their
convenience, and organize the new Board.

Dk. R. H. Lewis : I move that the conjoint session of the
State Board of Health with the Society be the first in order
after dinner.

Motion carried.

The President : The Society stands recessed until 3
o'clock this afternoon.

The newly elected State Board of Medical Examiners met
during the session of the State Medical Society in Winston.
received the papers and books of the former Board and duly
organized by the election of Dr. Jno. C. Rodman, of Wash-
ington, President, with Dr. Benj. K. Hays, of Oxford, Secre-
tary-Treasurer.

The assignment of subjects is as follows:

Dr. Jno. C. Rodman, Chemistry and Paediatrics.

Dr. Benj. K. Hays, Materia Medica.

Dr. Lewis B. McBrayer, Surgery.

Dr. Wm. W. McKenzie, Anatomy and Histology.

Dr. Henry H. Dodson, Practice of Medicine.

Dr. John Bynum, Obstetrics and Gynecology.

Dr. J. L. Nicholson, Physiology and Hygiene.

96 FIFTY-FIFTH ANNUAL SESSION"

Wednesday Afternoon, Jime 17th.

The Convention called to order at 3 'SO with the President.
Dr. J. Howell Way, in the chair.

The President : The Society will be in order. We will
now have the conjoint session of the State Medical Society
and the State Board of Health. Gentlemen, the Chairman
of the State Board of Health, Dr. George G. Thomas, who
will preside over the conjoint session.

Dr. Thomas : The State Board of Health is now open to
business. We will be glad to have the report of the Secretary.

Eeport, ''Conjoined Session State Board of Health," Dr.
Eichard H. Lewis, Ealeigh, K". C, Secretary. (Eead. See
Index. )

Dr. Thomas: Gentlemen: You have heard the report.
Are there any remarks thereon ? Then, if there is no objec-
tion, the report will go on file.

Gentlemen, it is my pleasure to introduce to you Dr.
Charles Wardell Stiles, Chief of the Department of Zoology.
Washington City, who will give you a special address on "Soil
Pollution, with special reference to Hook-worm Disease."

Dr. Stiles : Before passing to the reading of my papei
I wash to say that Surgeon General Wyman sends his best re-
gards to the Association, with his best wishes for a successful
meeting.

I have taken the liberty of changing my paper somewhat
although I shall speak on the same general subject as in the
program. The title of my paper reads: (See Index.)

Dr. Thomas : I would like to say that I owe Dr. Stiles an
apology for my error in introducing him. He is well knov\m
to this Society.

Dr. Julian : I am sorry that I did not get here in time tc
hear this very valuable paper of Dr. Stiles ; but some years
ago Dr. Stiles came to mv town and assisted me in eradicatine

N. C. MEDICAL SOCIETY. 97

hook-worm disease at the Thomasville Orphanage. At the
time he assisted me he was satisfied the box privy was the
source of the epidemic. I reported the matter to the trustees.
We pulled down the box privies, dug a deep well, have water
throughout the building, and after a few mouths we have
never seen a case of the disease.

Dk. Lew^is : I wish to call to the attention of the Society
that the laboratory, as it already knows, is ready to make ex-
amination of the ficces. All they have to do is to write the
laboratory at Raleigh for a container and send a sample o.
the fieces to the director of the laboratory.

De. Juliax : The examination is very easily made by any
doctor who is acquainted with the microscope by introducing
the finger into the rectum, getting a small amount of the
faeces, placing it on the slide, and in a few drops of water.

'Alilk Supplies in Relation to Public Health," Dr. Tait
Butler, State Veterinarian, Raleigh, X. C. (Read.)

Dk. Silvio von RxjcK;, Asheville : I have listened to Dr.
Butler's paper with much interest, but he has made many
statements which are radical and not proven.

He tells us that tuberculosis is transmitted from cattle tc
man with great frequency, and even that bovine tuberculosis
is the almost exclusive source of infection for man, while
human infection through sputum is of little importance.

He has misquoted Prof. Koch, who did not state that in-
fection of man by milk of tuberculosis cows could not happen
at all. Koch announced at the London Tuberculosis Congress
in 1901 that he had not been able to produce infection in cat-
tle Math tubercle bacilli of human origin, that the human
and bovine type of bacillus were not identical; that in the
light of the rarity of primary intestinal tuberculosis and rea-
soning; l)v analosT he did not believe that human infection
from bovine sources was of frequent occurrence. He did not
deny that might never occur.
7

98 FIFTY-FIFTH ANNUAL SESSION

There are two sides to this question, one of which Dr. But-
ler has entirely ignored, and aside from bacteriologic investi
gations and animal experimentation we have much evidence
in support of Koch's position. This also requires consider-
ation.

For example, it is well known that in Japan, before for-
eign cattle were imported, bovine tuberculosis was not prev-
alent. Further, the number of cattle in proportion to the
population is so small that milk is not an ordinary article ol
diet. N^evertheless Japan has shown and continues to show
as great a pro rata mortality from tuberculosis as other coun-
tries. In Sweden and Norway, where almost all children are
nursed by their mothers, there is as great a percentage ol
tuberculosis mortality as in countries where cows' milk is more
commonly used for infant feeding.

In Berlin records have been kept of the method of feeding
infants and the number of deaths from tuberculosis is equall^
divided, as shown by statistics cited by Fraenkel, between
those who were nursed by the mothers and those w'ho wert
fed on cows' milk.

There is much more evidence of like character which tends
to show that the tuberculosis of cattle is not the great sourer
of danger that has been asserted, but an actual experiment oi
man has been made, although at the time not with the view of
determining this question.

Baumgarten has given us the details of it. Based upon
Bokitansky's theory of the antagonism between tuberculosis
and cancer, a number of patients suffering from inoperable
malignant disease were inoculated with bovine tubercle bacill:
in the hope that their malignant disease might thereby be
favorably influenced. All eventually died of their malignant
disease and Baumgarten perfonned the autopsies. He found
no evidence of tuberculosis and even critical microscopic ex-
aminations failed to reveal tubercle or tubercle bacilli.

As Dr. Butler has stated, it has been found that primary
intestinal tuberculosis is not quite as rare as was supposed

N. C. MEDICAL, SOCIETY. 99

at the time Prof. Koch made his announcement in London
but while the thoracic glands may become affected as a result
of ingestion of tuberculous material this, according to all re-
sults and investigations, is rare. It is generally conceded that
by whatever route the bacillus enters, be this by ingestion or by
inhalation, the first localization occurs in the nearest regional
lymph gland. How^ever, since 1901, the subject has been
most carefully and painstakingly studied at the Imperial
Health Bureau in Berlin and elsewhere, and it has been
j)roven conclusively that in the majority of cases of primary
intestinal tuberculosis the tubercle bacilli isolated from the
intestine or mesenteric glands were of the human type. Up
to the present time the cases in which bovine infections have
been proved to have occurred in man are about 33 in num-
ber, 18 of which have been examined at the Imperial Health
Bureau, while 15 are reported by other observers.

Apart from any danger to man from tuberculosis of cattle
the question is of importance from an economic standpoint
as well, and if, as appears, the danger to man is but little, it
should not be necessary to destroy hundreds and thousands of
cattle simply because they be shown to have acquired tubercu-
losis.

Besides, as Prof. Koch points out, we can protect ourselve?
from such danger as there may exist, by boiling the milk and
cooking the flesh of such cattle as are or may be tuberculous.

With Dr. Butler's views as to the importance of cleanliness
in our dairies, I w^as heartily in sympathy. Irrespective of
the tuberculosis question, clean milk is essential, and for many
other reasons we should use our influence to obtain it.

Db. Burroughs, Asheville, IST. C : Mr. Chairman: 3
have listened to Dr. Butler's paper with interest. But there
are one or two points on which I think that the doctor, as our
State veterinarian, has not been sufficiently explicit.

I wish to state that no tuberculosis cow should be milked
nor is milked at any dairy that produces healthful milk. The

100 FirTY-FIFTH ANNUAL SESSION

herds are usually tested every six months. And all addition!-
to herds are tested before being allowed to mingle with tht
cattle already tested.

Dairy cattle of Asheville are under the direct supervision
of a veterinary surgeon ; and all milk is under the supervision
of one man, who tests milk at his will, with full authority tc
act.

The cattle are kept on the hills and in the valleys a portion
of the day and also a part of the night. And the milk is col-
lected twice daily.

The cattle are driven to a large corral with a shed attached
to the stables where they are fed. In this shed the, cattle art
brushed off, and while they are being fed their teats arc
washed with an antiseptic solution. Following this come the
immaculately dressed milkers wdth strainer pails. The milk
is then carried to the chemist with his assistants, where it is
standardized according to the requirements of Mr. Wilson in
the Department of Agriculture of the United States Govern-
ment. The milk is then iced and delivered in sealed glass
jars.

One statement made in Dr. Butler's paper I do not under-
stand, and I am certain that other members of the conjoint
session do not understand, which I wish the doctor to explain,
and it is this : that "thoracic tuberculosis is very frequentlv
contracted from the cow's tail." (Laughter.)

Dk. Butler closes: Just a word in reply to the gentle-
man's (Dr. Burrough's) thrust. I didn't say it.

I know I didn't cover this subject thoroughly. If I had
I would have kept you here until to-morrow morning. I stated
in the start I wasn't going to talk to the specialists and in-
vestigators, but to the general practitioner.

I could meet Dr. Von Ruck's statistics with statistics il
time would permit. I could tell you of investigators whc
have found as high as 41 per cent of the abdominal tubercu-
losis of children of bovine origin, but I did not have time tc
do it or to go into this matter fully.

]S'. C. MEDICAL SOCIETY. 101

I wanted to say further — and I tbonght I made that point
clear — that the old idea that you can tell the mode or channel
of entrance of the tubercle germ by the location of the lesiun
is no longer tenable. It is nonsense to say, because you find
tuberculosis in the lungs, that the germ necessarily entered
through the air passages. I said you could put the germs in
the tail of the cow and the chances were the tuberculosis would
develop in the lungs, not in the tail. Why ? Because tuber-
culosis is primarily a disease of the lungs, and the germs go
to where they like to live. They find the most suitable place
for their development. You can inject the tubercle germs
into the abdominal cavity, and you may feed them through
the mouth ; you may put them into the circulation or into any
part of the system, in any way you like, and in the majority
of cases you will get tuberculosis in the lungs. That is what
I meant to say. Thank you.

My paper is better explained with the drawings given the
Secretary.

Dr. Thomas : Genilemen: The next subject to be pre-
sented is ''Pellagra."

De. Joh^' Eoy Williams: J/r. President: I rise to
pray a special privilege.

Dr. Thomas : This is the conjoint session. When the
State Society reconvenes I have no doubt the doctor can be
heard. Is it relating to the Board of Health's business that
we are on now ?

Dk. Williams : ]^o, sir.

Dr. Thomas: Well, sir, as soon as we are through with
this meeting and we go back to the State Society I think you
will receive every courtesy.

Paper on "Pellagra" read by Dr. J. E. Wood, of Wilming-
ton, N". C.

102 FIFTY-FIFTH ANNUAL SESSION

DISCUSSION.

Dr. Sixes: Mr. President: I rise to introduce a motion
in regard to order in the house, that we who have devoted our
time to come and hear papers may hear them.

So far as we all know that was a most excellent paper read
before this Society just now, and I know one-fifth of the
men in the house did not hear this paper ; and for the benefit
of the Society I would be willing, at the expense of the So-
ciety, to place a doorkeeper at every available entrance to see
that no member should leave or come in during the reading
of a paper. They have the program. If they are not inter-
ested in the paper being read let them remain in the lobby;
otherwise I think it would be well for the Society to adjourn
and let us go to the sick, who need our services.

De. W. S. Rankin : I am in favor of doing anything that
will produce order in the house, Mr. President. I pledge
you my word, sir, I did not hear ninety-eight per cent of that
paper. If that paper had been read loud enough, I believe
the same attention would have been given it as was given to
the valuable paper which preceded it.

"Pellagrous Insanity," Dr. John McCampbell, Superin-
tendent State Hospital for Insane, Morganton, iST. C.

DISCUSSION.

Dr. W. p. Whittington, of Asheville, N. C. : Mr. Pres-
ident: I just want to add a few words in the report of a
case that I saw a few years ago. A young man in good physi-
cal condition went from Asheville to Pittsburg, Pa., and
while in Pittsburg, after being there two or three months, he
contracted what I now know to be pellagra. He went under
the treatment of different physicians there for about two
months, expecting to get well, but he got worse all the time<
He stopped at Greenville, in East Tennessee, about a month
where he was under the care of a physician he knew, expect-
ing to improve, but got worse all the time. He then returned

N. C. MEDICAL SOCIETY. 103

to Asheville, having had the disease about four months after
he left Asheville. He called to see me after he got back and
I knew there was something the matter with the intestinal
tract. He seemed to have gastro-enteritis. He had that char-
acteristic ervthemtous condition on the hands, extending up
to the wrist, as far as the hand was exposed to the sun. He
was very much emaciated and I thought he would die, but 1
put him on treatment for the symptoms, not knowing what
the true cause of the condition was.

I want to mention the treatment, not knowing whether his
coming back to Xorth Carolina, where we have better corn,
cured him, or he got well from some other cause. I gave him
nitrate of silver, bismuth and opium. After that I put him
on arsenic, and in three or four months the man appeared to
be perfectly well, and is well to-day, five years, and has had
no recurrence whatever.

Another case mentioned by Dr. McCampbell, of Morganton.
It was a lady attacked with similar symptoms, but soon after
she was attacked her mind became involved and she was sent
to the asylum and there died.

I merely mention these cases. I did not know what they
were at the time, but afterwards learned that they were pos-
sibly pellagra.

One of these, I think, originated in Pittsburg, Pa., and the
other had not been out of Buncombe County, and was due.
perhaps, to the infection received there.

Dr. I. M. Taylok, Morganton, IST. C. : I have seen in my
practice, I believe, five cases which I can account for as pel-
lagra. Of these four have died ; the other seems to have made
a recovery. Three of these were men and two women. Three
were intemperate people, and I accounted for their skin con-
dition as the result of alcoholic abuse.

I confess that I have never made a diagnosis of the dis-
ease, and only since this discussion has opened in the journals
and since reading the paper of Dr. Babcock have I recognized
that I had been dealing with this condition.

104 FIFTY-FIFTH ANNUAL SESSION

I accounted for the general skin and nervous symptom as
malnutrition, and in the case of two men and one woman
directly due to alcoholic abuse.

Dr. Stiles : I have seen two cases, one in South Carolina
and one in Alabama, both recorded by the physicians who
had them in charge. In one of these cases my examination
was made and coincident thereto parasitic infection was
found.

The question is raised. Is not pellagra of parasitic infec-
tion ? If it is, it is something new to me.

The two cases that I saw, in Alabama and South Carolina
one is totally different from any symptom I ever saw.

In connection with the alleged cause it is interesting to
note that it is particularly in Antwerp, Bremen and Copen-
hagen that complaints have been made regarding spoiled
corn ; and yet in that part of the world pellagra is unknown

I mention this as an interesting fact — that spoiled corn
does not seem to cause the disease.

De. W. S. Rankin: I desire to report a case that is in.
teresting in the light of this recent and valuable work on
pellagra.

The patient, a young man twenty-five years of age, a stu-
dent at Wake Forest College, has suffered every spring and
summer for the last three years with a peculiar skin lesion.

The lesion, symmetrical in distribution, consists of an ab-
normally smooth, hairless, slightly red and sensitive skin
about the size of a dollar, on the dorsal surface of the hands
just above the metacarpo-phalangeal articulation.

Knowing Dr. Wood's interest in the relation of malaria tr
Raynaud's disease, and believing this case to bear some re-
lation to some of the varieties of Raynaud's disease, I referred
the case to him.

At his suggestion the patient began a course of Fowler'e
solution, but was unable to note much change in his hands.

In April of this year the patient consulted my colleague

K. C. MEDICAL SOCIETY. 105

Dr. Gaines, whose attention had been attracted by recent liter-
ature to the relation of certain skin lesions to intestinal in-
toxication as evidenced by well-marked indicanuria, and the
relief of the skin lesion by medication addressed to his in-
testinal trouble.

On examining the urine a well-marked indicanuria was
evident.

The patient was given sodium phosphate enough to produc
two motions a day, with salol 5 grs. every four hours. Within
two weeks the skin lesions had almost disappeared.

Since Dr. Stiles has mentioned it I am almost sure that
two years ago I found this man with a very light uncinariasis.

Dk. Daltox: I would like to make the announcement,
over at Xissen Park we have a supper prepared for the So-
ciety which ^^dll be ready at 7 :30, and as soon as you can ad-
journ you take the cars going south at once.

Dr. Thomas: Gentlemen: It is not necessary for me tc
repeat such a pleasant invitation as that. I am sure it will
appeal to you.

If there is no more business before the conjoint session
we will now adjourn.

The session is now adjourned.

The President, Dr. Way, resumes the Chair.

The Peesidext : Gentlemen.: It is moved and seconded
that the Society take a recess until the conclusion of the sup-
per at the park to-night, at which time the work of the session
will be resumed, the annual oration and the annual essay will
be delivered.

Those favoring the motion say "Aye." Those opposed
"Xo." Motion carried. The Society stands recessed.

106 riFTY-riFTH ANNUAL, SESSION

AT THE BANQUET.

Wednesday Evening^ June 17th.
Informal session held in the dining pavilion at Nissen Park.

Dr. Hodges: Ladies and Oentlemen: Your unexpected
courtesy on this occasion is exceeded only by my inability tc
adequately express my appreciation.

I recognize, however, that I am called upon not to sj)eak
personally but for my professional brethren, and in their name
to return thanks to the good and generous people of this city
for their most hosj)itable entertainment.

I never return in these latter days to this grand old State
that I am not impressed with the generous impulses and
loyal-hearted w^elcome of her people.

I recognize also, and admire more than I can tell you, the
broad-minded sympathy of feeling and action that I always
find in evidence, and which, to my mind, accounts in large
measure for the :wonderful development which is manifest ou
every hand.

In the State of my adoption we love relics and are too prone
to cling to the things of the past, but here I find the old and
the new side by side in sweet and suggestive harmony and
accord, the one adorning and illustrating the other.

Since coming again to this historic and progressive city,
after twelve years absence, I have been charmed by the beauty
of your ancient landmarks, and amazed at the development
of your commercial and industrial activities.

Since leaving the hotel an hour ago to come to this banquet
I have been impressed with the numerous and varied manu-
facturing interests that were represented along the route.
Woolen mills, cotton factories, tobacco factories, furniture
factories, lumber mills and various manufacturing concerns
of different kinds, and even an iron bed factory that appeared
homelike to me, as representing hospital work, were all iu
evidence, and if wdiat I saw on this ride be typical of the in-

N. C. MEDICAL SOCIETY. 107

dustries of this city it surely has a future of which you and
^xe all may be justly proud.

In fact, when I look into the faces of the people of my na-
tive State, assembled here this evening from all sections, J
feel proud of the land that gave me birth and feel that it is
not yet what it will be, for with the continuation of such prog-
ress as has marked the past few years the Old iSTorth State
will become a beacon-light of prosperity, seen and envied bv
all her enterprising sisters.

I am confident, too, that some of this great enterprise, some
of this successful development, if you please, is due, not alone
to the men who are sounding for us the true note of success
but to their helpmeets who on such occasions as this are ever
foremost in good works, and always doing so much for the
future of the land they love so well.

In conclusion, I know I but voice the sentiment of all my
friends and brothers in the medical profession when I return
to the ladies of the Hospital Committee, both Senior and
Junior organizations, our most heartfelt thanks for theii
beautiful and bountiful provision for us here to-night.
" They talk about a woman's sphere
As though it had a limit;
There's not a life, or death, or birth.
That has a feather's weight of worth,
Without a woman in it."

(Applause.)

The Society recessed for half an hour, when the session
was resumed in the open pavilion.

The President^ Dr. Way: Gentlemen: I have the
pleasure and honor of introducing to you Dr. Charles S. Man-
gum, of Chapel Hill, who will deliver to you the annual ora-
tion. (Applause.)

'"The Annual Oration, the Physician and Education," Dr.
Mangum.

The President: Ladies and Gentlemen: I now take
pleasure in presenting to you Dr. Thomas E. Little, of
Greensboro, who will read the Annual Essay of this body
'The Lines of Progress in the Practice of Medicine."

108 FIFTY-FIFTH ANNUAL SESSION

The President : On behalf of my colleagues of this So-
ciety I wish to extend our most sincere thanks for the pres-
ence of the ladies and the gentlemen of Winston at this, our
evening session, and especially for the most delightful and
superb entertainment in the adjoining building with which
we have been regaled.

I also appreciate your interest and attention in these two
carefully prepared dissertations upon the physician and mod-
ern education and lines of modern progress in the treatment
of disease ; but before telling you good-night I want to intro-
duce another number that is not upon the printed program.

We have been in session for the two days past in your beau-
tiful and progressive city, and we have been hard at work,
and for long and continuous sessions of ours mind has been
pitted against mind, in consideration of the serious and scien-
tific subjects that engage our attention at these annual meet-
ings, and we have not had much time for fun. But the spirit
of fun is in us, even though we don't look like it, and we have
with us to-night a gentleman whom this Society has for more
than a quarter of a century been delighted to honor, and its
honors have always been placed where they were merited. He
is a gentleman accomplished and cultured in every sense of
the word ; he is a skilled and learned physician, who is the
head of the Health Department of the State of jSTorth Caro-
lina, and who while the two millions of men, women and chil-
dren in this State sleep it is said that Dr. Lewis never sleeps
because he is always awake, looking out for the good of the
health interests of the people of jSTorth Carolina.

But Dr. Lewis is not only a great health officer and a great
physician and a great gentleman, but a very gifted story teller
as well, and I now ask Dr. Lewis to tell us one or two — I will
not limit it — of his delightful stories. (Applause.)

De. Lewis: Mr. President, Ladies and Gentlemen:
Whenever I am called on unexpectedly to make a speech, I
am always reminded of the story of old ITncle Simon, one of
those old-time darkies, who, as you know, are generally

N. C. MEDICAL SOCIETY. 109

"mighty po'lj," "way down in de low-grounds er sorrow/' as
they say.

One night Uncle Simon was walking along the street in a
little village, talking out alond to himself about his ailments
and troubles, and wound up his soliloquy by wishing "dat de
good Lord would send down de Angel Gabrul, and ca'y ole
man Simon home to his ole Marster, where he belong." Some
mischievous young men overheard him, and some time after
he had got home, they went to his cabin and knocked at the
door. "Who dat ?" said the old man. "It's the Angel Ga-
briel, come to carry old Simon home to his old Marster."
"Lord, j\Iarse Gabrul, ole man Simon done move 'way f'um
here tw^o ye'r ergo." (Laughter and applause.)

I always feel like old man Simon. At the same time,
after the very flattering introduction by my friend, I could
not be so imgracious as to fail to respond.

I was very much pleased with what the orator had to say
about our State Board of Health. Every doctor is essen-
tially the health officer of the families in which he practices,
and without the support and cooperation of the medical pro-
fession, it is practically impossible, no matter wliat legisla-
tion may be secured, to carry out the principles and prac-
tice of sanitation.

I hope the words of the orator may sink deep into the
hearts and minds of my brethren who heard him, so that they
may lend their aid to this great work.

I want to give you a piece of advice in regard to the hand-
ling of a mule.

A negro was driving a mule hitched to a cart through one
of our Southern tow^is, when she balked. Failing to get her
to go, he went into a near-by store and asked the proprietor if
he would let him "forme" to his Marse Tom. He agreed,
and the following conversation, at the colored end, ensued.
"Ls dat you, Marse Tom? Yaas, sir, dis is George, sir.
Marse Tom, ole Jinny done balk ergin, sir. Oh, yas, sir, I
wo' the hoop out on her de fus' thing, but it never done her

110 FIFTY-FILTH ANNUAL SESSION

no good, sir. Yas, sir, I put dirt iu 'er mouf, and I tied er
string roun' her y'er, too, sir ; but she never move, sir. Yas,
sir, I built er fire under her, sir, and de cyart all burn up.
sir, but she's er standin' right dar, sir. Oh, yas, sir, I tuck
de things out'n de cyart an' put 'em on de sidewalk befo' 1
built de fire, sir. JSTaw, sirj naw, sir; I never twis' her tail,
sir; but er gemmum fum de ]S"awth he come arlong, sir, an'
he twis' her tail, sir. Yas, sir ; dey sont ofl: to de liv'ry stable.
an' got a ca'age an' tuck him to de horspittle, sir. jN aw, sir ;
I ain't heerd, sir." Applause. (Encore.)

I will tell you a brand new story I have just heard from
my friend, Dr. George Thomas, who is the President of our
State Board of Health, and likewise Chief Surgeon of the
Atlantic Coast Line Eailroad. He is a splendid story-teller
and I wish he was here to tell it. I can't do it justice. The
point of the joke, the doctor said, Avas that it was on himself.
Recently the doctor was jollying a very homely railroad friend
on his looks, when turning to the gentleman with him, he
said: "Mr. E, you see Dr. Thomas's bald head and his whitt
hair and his white moustache? He has dark eyebrows still,
but he reminds me of a love-feast I heard of the other day.
The minister called on different members of the congregation
to give in their experiences, asking Brother Browning if he
could not get up and tell the people what the Lord had done
to him. He did so, recounting the many blessings he had
received. Then he called on Sister Fairfield and others.
Finally his eye fell on the face, then in repose, of a gentle-
man who had suffered a stroke of paralysis six or eight months
before, and who was peculiarly affected in that whenever lie
attempted to talk one side of his face would spasmodicallv
draw up, and he remarked, "Brother Jones, won't you kindly
get up and tell the people what the Lord has done for you
during the past year ?" Rising to his feet, in his tottering,
paralytic w-ay, one side of brother Jones's face flew up with a
jerk, and he remarked, "Well, He mighty nigh mint me."
(Laughter and applause.)

K". C. MEDICAL SOCIETY. Ill

[After the remarks of Dr. Lewis, the President, Dr. Wav,
declared the Society recessed until 9 :30 Thursday morning.
Thus closed the social evening, one of the most pleasant of
the Society's meetings during the week. The local profes-
sion and the ladies of Winston-Salem had been most lavish
and untiring in their efforts to make the social evening of
the session a complete success, and it is a pleasure to here
record the oi3inion that never has the Society in its history
been more charmingly entertained. The hall was beautifully
decorated and the more than five hundred ladies and gentle-
men who graced the banquet board were delighted with every
feature of the occasion. The refreshments were most abun-
dant and choice, the serving hospital)le to a degree, and the
occasion, while wholly informal, with no addresses save the
impromptu remarks of Dr. Hodges, one to be recalled with
pleasure. — Editoe. ]

Thursday Morxixg, June 18th, 9 :30 a. m.

The President, Dr. Way, in the chair.
The President: Gentlemen: The meeting will come to
order.

Dr. Fraxk Duffy: Mr. President: I ask unanimous
consent to present a very brief resolution on behalf of one of
our oldest members.

The President : Without objection, consent will be
given.

Whereas, Dr. J. A. Reagan was to have attended the meeting and
contributed a paper thereto, but has been prevented by illness :

Be it Resolved. That we regret his absence, and sympathize with him
in his affliction.

Seconded by Dr. Stanton. Unanimously carried.

The President: Gentlemen: We will resume consid-
eration of the program at Xo. 30 — "The Pelation of the
General Practitioner to Gynecology," Dr. J. E. Stokes, Salis-
bury, X. C. (Read.)

112 FIFTY-FIFTH A^^KUAL SESSION

De. "\Yeavee: il/r. President and Gentle^nen: To my
mind this is one of the most serviceable and practical papers
that has been presented to this Society. It truly divides the
subject between the general practitioner and the gynecologist.
and I am glad to hear the expressions coming from such an
efficient specialist as we have heard to-day. The time is now
past when everything is relegated to the specialist. From
my experience I make this statement : that tw^o-thirds of the
cases in gynecology are attributable to the want of perfect
nutrition in the body of the female, and if the general prac-
titioner takes due vigilance of his case and looks at the details
builds up the system, obtaining perfect metabolism, taking
all the general symptoms into consideration, he will prevent
many capital operations.

A great majority of the cases lack proper management ;
which is in the hands of our general practitioner.

Constipation is one of the most fertile sources of these
minor diseases of the female. Therefore, the thing to do is
to treat the system in a general way, by the general practi-
tioner, and many times he can so avert the calamity which
comes in the after days.

The time is not gone yet when a properly fitted pessary, or
a tampon, in the hands of a general practitioner, may lift the
uterus up from its displacement, giving it good nutrition, and
by the tonic treatment of the general system, and the re-
moval of toxins, and the open air exercise, these minor dis-
eases can be cured.

But, mind you, there is a line that we must draw, where
the practice of the general practitioner stops and the surgeon
takes charge — whenever the abdomen is to be opened. When-
ever we invade the peritoneum, then the general practitioner
should stop and deliver it over to our brethren, who make a
specialty of abdominal operations in surgery. Therefore this
paper is of importance to us all— we general practitioners-—
and we should take heed to the things that it contains, and we
will all profit a great deal by this timely advice.

N. C. MEDICAL SOCIETY. 113

Dk. Stokes : I have nothing further to sav. I thank the
doctor for discussing my paper.

Dk. J. T. J. Battle: J/r. President: I have a motioi
that I wish to bring before this Society, and I move that a
committee of three be appointed to confer with the Publica-
tion Committee of this Society in regard to some apparent
discrepancies in the different prints of the Constitution and
By-Laws of the Society. I hold in my hand a copy of the
Constitution and By-Laws as adopted at the Hot Springs
meeting in 1903. In comparing this with the proceedings
since then I find that there are some differences, which may
be typographical or errors that could easily slip in, and to get
these two copies together, I make this motion.

It is sometimes courtesy to appoint the mover of a motion
on that committee, I believe. To assure you that I do not
want to be on that committee, I include in that motion, as
Chairman of that Committee, Dr. Kent.

Seconded by Dr. Weaver. Motion carried.

The President : The motion prevails. Have you fur-
ther suggestions as to the personnel of the committee ?

Dr. Battle : ISTo, sir ; none whatever. I just didn't
want to be on it mj^self .

Dr. Kent: Mr. President: As long as Dr. Battle has
made that motion and dodged, very nicely, as he thinks, the
responsibility of doing that work, I move, sir, that Dr. Battle
be made one of that committee.

The President : It is the province of the chair, I believe,
to appoint, and the chair was only asking the question as a
courtesy. I take great pleasure in appointing Dr. Battle.
Have you further suggestion as to the other member?

Dr. John Roy Williams: As we have present with us
to-day one of the original drafters of the Constitution and
By-Laws, I move that he be included on that committee. ]
refer to Dr. M. H. Fletcher.

114 FIFTY-FIFTH ANNUAL SESSION

Dr. J. P. Turner: While we are on this little business
for the good of the order, I would like to bring up a matter
that I have been appointed to bring up, by the Guilford
County Medical Society, for the good of the order, and would
like to present this matter to the Society this morning for its
consideration, if it is in order.

The President : What is the character of the matter that
you refer to, Dr. Turner ?

Dr. Turner: It is a matter of the resolutions passed ai
a called meeting of the Guilford County Medical Society and
placed in the hands of its members to bring here and present
before this Society for its consideration. This resolution will
explain itself. It embodies a great many principles looking
toward the betterment of the conditions of the profession o±
North Carolina, and, as I consider it, is for the good of the
order. I would like to read them to you.

The President: I would just ask, doctor, if this is a
matter of an ethical character, or involving ethical questions 1

Dr. Turner : I should say that it was, to a certain extent,
but it is a matter that we, as a County Medical Society, think
that the whole profession of the State of North Carolina is
interested in; if it is not, it should be, because if it is not
taken up at this meeting. and discussed and disposed of, it is
going to work detriment to our Society. I would like to read
sir, the resolution, if you will permit me.

The President: Dr. Turner: Under the section of our
Constitution which reads: "All questions of an ethical nature
brought before the House of Delegates, or the General Meet
ing, shall be referred to the Council, without discussion."
Under that section of the Constitution I will refer considera-
tion of that matter to the Council of this Society, and request
that you file the papers with the Secretary, who will at once
place the matter before the Council, and the Council will
designate a time for the consideration of this ethical matter.
That is the decision of the chair upon this point.

N. C. MEDICAL SOCIETY. 115

Dr. Turnee : "Will you allow me just a few words on this
question ?

The Preside^'t: Certainly. Dr. Turner.

Dr. Tur^'er : I understand that law that you have quoted
thoroughly; I think that a matter of ethics — as differences
occurring between brother physicians in some other county in
the State, that has been taken up by the local society, has gone
by the Board of Censors there and appealed from their de-
cision to this body — I agree with the chair that it is right;
but in this instance, gentlemen, this is not a matter of ethics,
involving one, two or three men, or one, two or three county
medical societies ; it involves every member of the Xorrh
Carolina State Society, and every honorable physician in the
United States, and I respectfully submit, Mr. Chairman
that we be heard, because, if it is not heard here, it is going to
hurt us, and hurt us bad.

Dk. Parrott : Mr. President, since you have permitted
Dr. Turner to make a few remarks —

The Pbesidext: Dr. Parrott: Where will the line be
drawn ?

Dr. Parrott : I would be pleased, sir, if the chair would
extend the courtesy. I suppose that I could extend the mo-
tion and ask the chair to move that it is in order.

I move that on account of the intense interest manifested
by the profession in regard to this matter, because of the sec-
tion which the chair has read of the Constitution and By-
Laws, because of the undisputed fact that the profession oi
iN'orth Carolina is an honorable one and means to do right
and to do it in order, that the matter be referred — since the
doctor has stated that the matter was a question of ethics — to
the Board of Councilors, in accordance with the Constitu-
tion, and that the Board be urged to assemble at the earliest
possible moment, take such action as they see fit, and refer
the matter back, as thev see fit, to us for consideration.

116 FirTY-riFTH A]N^NUAL SESSION

Dk. Bahkson: I beg to submit an aiiieudmeut to that
motion, to this effect: That the Councilors be invited now
forthwith, to sit and hear, in the presence and in the full
hearing of this body, these charges. (Applause.)

Dk. Pakkott: I believe, Mr. Chairman, that the gentle-
men present are extremely anxious that this matter be dis-
posed of in an orderly and proper w^ay. So far as I am per-
sonally concerned, I believe that it should be done, and I am
confident that the profession of jSTorth Carolina intend to dc
right toward every member, regardless of personal prejudice
or personal feeling, and I am satisfied that if there is a man
in North Carolina who means to do the square thing, thai
man is Dr. Bahnson. (Applause.)

I believe, sir, that Dr. Bahnson would lead the profession
of North Carolina aright in this matter, and, so far as I am
concerned, whenever the time comes that my judgment must
run contrary to his, I would do so with fear and trembling.
because I feel that Dr. Bahnson's experience and right judg-
ment would make him competent to judge. But, gentlemen,
there is a time when the best of us are swept off our feet be-
cause of some catchy statement.

jSTow, Dr. Bahnson's amendment is fill right, if the Society
has time to go into the matter. Therefore I personally dn
not object to that amendment except on the ground that it
would take up too much time to Avash linen here, when it
ought to be threshed out and brought to us here, when it ha'
been deliberated upon.

Dk. Knox: Mr. President: In speaking as a second to
Dr. Bahnson's motion, I think I can put it upon a broad
ground that will appeal to every member of this Society. T
believe Dr. Bahnson's motion is the correct one.

Dr. Paerott : I am not kicking on his motion at .all.

Dr. Kxox : I believe it is right to pass Dr. Bahnson's mo-
tion, for tw'o reasons: The first and highest of all, in my

N. C. MEDICAL, SOCIETY. 117

judgment, is that this, in mv opinion, is a direct message — a
special message — from the Guilford County Medical Society,
a company of sixty-three of the best physicians of the State ; a
special message from the Guilford County Society to the
Medical Society of the State of iN'orth Carolina, and I thinl;
that the Medical Society of this State ought to listen respec;
fully to a special message of that kind. (Applause.)

I believe that if we refer this thing, in a i3reliminary way.
to the Board of Councilors alone, and they take it into a pri-
vate room and consider it, and then have to bring it before
our body, with many of the gentlemen obliged to go off o:
this 11:35 train, we Avill have but a handful to hear it. Dr.
Bahnson's motion covers the ground absolutely: that it shall
be referred, in an orderly way, to the Board of Councilors,
but that the Society respectfully requests those Councilors to
have that hearing in the Society.

The President : Gentlemen: The Constitution says that
the decision of the Council in all such cases shall be final.

Dr. Bahnson: Mr Chairman- Excuse me; may I have
the floor a moment ?

The President : Certainly.

Dr. Bahnson: We have not a particle of objection to
the decision of the Council being rendered on the evidence in
our presence, and we will be glad to hear their decision as
soon as they have heard the evidence, and if it is not satis-
factory, the Constitution provides for a referendum, which
will override the decision.

The President: Gentlemen: The question is upon the
addition of the amendment of Dr. Bahnson — that the Coun-
cil be invited to sit in the matter, in the presence of this
body. Those favoring the adoption of the amendment signify
it by saying "Aye." Those opposed, "^o." Motion carried.

The President : ISTow the question is the original mo-
tion, as amended by Dr. Bahnson. Motion carried.

118 FIFTY-FIFTH ANNUAL, SESSION

The President: That matter is leferred to the Board
of Councilors, with the request that they meet at once and
consider it in this hall. The Secretary will call the roll of
the Council, th-it I may formally place this matter in their
hands for immediate action.

Dk. Knox: Mr. President: I understand the amend-
ment to be that they be respectfully requested to sit and hear
this thing in the body of this Society.

The Pkesident: That was the understanding of the
chair.

Dr. Bahnson: Unless I am misinformed — I hope T
am — the roll-call wall disclose the fact that urgent business,
either from this or the other side of the line, has called the
majority of the Councilors to their respective homes, and
therefore I wish to ask the desire of the Society whether they
Avill hear this message from the Guilford County Medical
Society before those Councilors, whether a quorum or not,
who are present ?

The Secketaey: As directed by the President, I will
call the roll of Councilors, and ask all who are present to
please respond. (The roll is here called.)

I find, Mr. President, two Councilors respond to the roll-
call.

The President: lISTow, gentlemen, I think we can solve
that difficulty for this body by appointing as temporary
Councilors, in the absence of a majority of the Council,
members of this body who are present to temporarily assume
the functions. (Applause.)

Dr. Bahnson: Mr. Chairman: I hope to get up such a
committee as will act without delay.

The President : Dr. Bahnson: You will excuse me, sir.
The chair is promptly attending to this business.

Dr. Bahnson : I will ask a personal privilege : The Con-
stitution gives the President no right to appoint Councilors
in the place of those who happen to be absent.

X. C. MEDICAL -SOCIETY, 119

The President: The ruling of the chair to that objec-
tion is that the general order of procedure in all parliamen-
tary bodies permits the presiding officer to appoint tempo-
rarih' to fill vacancies, and in pursuance of that, the Secre-
tary will call the roll of the Councilors, and the chair will
proceed to fill the place of those who are absent. I may ask
Dr. Bahnson to help me. (Laughter and applause.)

The Secretary: The First District, Dr. Oscar McMul-
len. (Dr. McMullen was absent.)

The President : Is there any gentleman from the First
District in the hall ?

(Counties of the First District called. Xo one present
from that district.)

The President: There appearing to be none present
from that district, we will pass that, for the present; I am
sure a majority of the districts are represented.

The Secretary: Dr. R. H. Whittaker, Kinston. (Coun-
ties of that district called.) (Dr. Whittaker absent.)

The President: I appoint Dr. J. !M. Parrott as tem-
porary Councilor for that district.

Dr. Parrott: Mr. President: I can not serve. It is
absolutely impossible. I am unwell to-day.

The President : The chair, for the present, will gently
insist upon Dr. Parrott's assisting us in this delicate and
important matter.

Dr. a. W. Knox : I wish to say one word. I know Dr.
Parrott has the courage of his convictions to do right, and his
determination not to shirk a duty. I am satisfied with his
inability to act in this important matter, and I ask that he
be excused.

The President: Is it the pleasure of the body that Dr.
Parrott be excused ?

120 FIFTY-FIFTH ANNUAL SESSION

Dr. Knox: I move that Dr. Parrott be excused on h
own motion.

The Peesident : Dr. Parrott is excused and Dr. Laugh-
inghouse is appointed from that district.

The Seceetaky: The Third District, Dr. P. H. Kus-
sell. (Dr. Russell absent.) (Counties called.)

De. Eveeitt: Dr. Harper, from Wilmington, is here.

The Peesident: Dr. Harper will sit with the Council-
ors.

The Secretaey: The Fourth District, Dr. Albert An-
derson. (Counties called.) (Dr. Anderson is absent.)

The President : Dr. E. T. Dickinson, from that district,
is appointed.

The Seceetaey: Fifth District, Dr. J. F. Highsmith
(Present.)

Sixth District, Dr. H. A. Rojster. (Absent.)

The Peesident : Dr. Royster is absent. I will ask Dr.
A. W. Knox to serve from that district.

The Secretaey: Seventh District, Dr. C. M. Strong.
(Absent.)

The Peesident: Is Dr. J. W. JSTeal present? (Absent.)
Dr. J. M. Blair? (Absent.) Dr. Sam Stevens is appointed
from the Seventh District.

The Seceetaey: Eighth District, Dr. J. B. Smith.
(Present.)

Ninth District, Dr. I. M. Taylor. (Present.)
Tenth District, Dr. J. A. Burroughs. (Absent.)

The Peesident : Dr. L. B. McBrayer will act as Tenth
District Councilor.

The members of the Council will please gather around thi?
table in front of the speaker's stand. I will then declare a
recess of the Society, pending a report of the Council as soon
as the Council is duly organized.

N. C. MEDICAL, SOCIETY. 121

PEOCEEDmGS OF THE COUNCIL.

The members of the Council, as per President's Way's re-
quest, gathered in front of the President's chair and pro-
ceeded to organize.

Dr. I. M. Taylor was elected President of the Council and
called it to order.

Dk. Taylor: The election of the Secretary is in order.
Will the Council name a Secretary ?

Dr. Stevens elected Secretary of the Council. Dr. Taylor
advised the President of the Council's being organized and
ready for business.

The President, Dr. Way: The gentlemen of the So-
ciety will be in order.

The Council has assembled, as per your instructions, and
are now duly organized and ready for the transaction of busi-
ness. Dr. I, M. Taylor has been elected President of the
Council; Dr. Stevens, Secretary.

The general meeting of the Society will now be recessed
and its members may sit, as per its instructions, with the
Council; and to him, as Chairman and presiding officer of
that Council, I tender the gavel to its duly elected President
pro tem., Dr. Taylor.

Dr. Taylor: The Council will come to order, and the
chair will hear the pleasure of the Council.

The Council particularly requests that we preserve order
in the hall, or we shall have to remove to a committee room.
Will there be order ?

Dr. J. B. Smith: Mr. Chairman and Memhers: I move
that this be referred back to the house for their decision.

Dr. Knox: There is no business before us at present.
The gentleman moves that this matter — I do not know what
matter — be referred back to the house.

It seems to be in order that the business to be broudit be-

122 FIFTY-FIFTH ANNUAL, SESSION

fore the Council should be succinctly stated, so that the Coun-
cil may then decide what course of action it will take. This,
as I understand it, is a respectful message from a duly or-
ganized County Medical Society — a component part of the
State Society. We have decided that the Council, sitting in
the presence of the State Society, will hear this matter. We
are entitled to a plain statement of what the matter is. It
seems to me it would be the proper course for the Council to
pursue to ask the messenger from the Guilford Society to
state w^hat the Guilford Society proposes to say to the Coun-
cil and to the State Medical Society.

Dr. McBeayek: 3Ir. President: So far as I am in-
formed, there is no business before this Council. I would
suggest that if any member of the Council, or any one else
has any business to present to this Council, that it be done at
once; otherwise that we adjourn.

De. Taylor: The chair holds the Council open for com-
munications, through the Secretary.

Dr. Stevens: Mr. President: I have a communication

here which will explain itself. I will read the card first :

"THE BIGGS SANITARIUM, GREENSBOEO, N. C.

"For the Cure of Chronic Diseases.
"Massage, Physical Culture, Electricity, Hydrotherapy, Electric-light
Baths, Mechanical Vibration, Diet, and other natural methods

"Especially Successful

"In the cure of Eheumatism, Digestive Disorders, Paralysis, Neurasthe-
nia and other diseases of the Nervous System.

Correspondence with physicians regarding cases requiring special
physiological treatment respectfully solicited.

"Charges moderate.

"The Biggs Sanitarium, Greensboro, N. C."

(The following is the letter from the Guilford County
Medical Society) :

The attached card is clipped from the June issue of the
Charlotte Medical Journal, which is being represented to us
as being the "Official Organ" of the ISTorth Carolina Medical
Society by one of its duly authorized agents.

N. C. MEDICAL SOCIETY. 123

Therefore, the Guilford County Medical Society wishes to
enter an emphatic protest against the publishing of this ad-
vertisement, which tends to suggest, or does in fact suggest,
the Xorth Carolina Medical Society as being endorsers of
this man whom we have endeavored to suppress by law.
Therefore we beg to offer the following resolutions and have
their adoption:

Resolved, That in the publication of the above-refened-to advertise-
ment, the editor of the Charlotte Medical Journal has openly offered
a gross and unwarranted insult to every member of this Society.

Resolved, 2. That we recommend that we withdraw our patronage
from the Charlotte Medical Journal until its pages shall have been
purged of all such unethical advertising as above referred to; and,

Resolved, 3. That we recommend that we refuse to patronize said
Journal until the editor shall have made satisfactory apologies to this
Society and to the Guilford County Medical Society.

Introduced by instructions from the Guilford County iledical Society,
in convention assembled, June 15, 1908, in the State Society in session
at Winston-Salem, June 18, 1908.

(Signed) John Eoy Williams, President."

Dr. Taylor: Gentlemen: The resolutions from the
Guilford County Medical Society are before you for consid-
eration. What is your pleasure ?

Dr. Knox: Mr. President: I desire to call attention to
one fact: We do not desire to impug-n the truthfulness of
anybody, but this clipping — we believe the gentleman who
made the statements — that that clipping is taken from the
Charlotte Medical Journal, but there is nothing on the clip-
ping itself to show that it Avas taken from the Charlotte
Medical Journal. I have a copy of the Journal here in my
hand. I will compare them. (The two papers were found
to be the same.) That comes headed The Charlotte Medicat
Journal, on page 6, June, 1908.

Dr. McBrayer: Mr. President: I want to state, sir,
in explanation of what I am going to say, that I have no de-
sire whatever to refuse to this gathering of medical gentle-
men the privilege of hearing any discussion upon this matter
that they care to bring up. I take it from the applause that

124 FIFTY-FIFTH AN:N^UAL SESSION

has been rendered here this morning that this matter is of
great interest, and that thej are anxious to hear it. At the
same time, sir, if I am going to sit with this honorable Coun-
cil, I should like to have everything in order and in proper
form, and, as I read this communication and study it, there
is no evidence whatever that this comes from the Guilford
County Medical Society. The paper is not signed by any
one.

De. Knox: The gentleman who read it, I understood to
read ''by John Eoy Williams, President." It is sigiied in
typewriting.

Dk. McBrayer: It isn't signed by any one, and no seal
of any Society is attached.

Gentlemen, I want you to understand that I have no objec-
tion to this, but I am not willing to consider a document that
is brought up in this way, and for those reasons, Mr. Chair-
man, I would like for you to take the paper.

De. Tayloe: The chair rules that the paper will not be
considered unless it is signed or a personal representative of
the Guilford County Medical Society appears before the
Council. Time will be given for that, and we will receive it
under those circumstances.

De. J. Eoy Williams: As President of the Guilford
County Medical Society — if I may be heard by this honor-
able Council — I beg to say that I will sign that, and, as for
the seal, every member of the Guilford County Medical So-
ciety present will sign it.

Dr. Taylor: The chair will receive the paper signed.
The suggestion has been made that this paper should be
signed officially by the President and the Secretary.

The Council is open to receive the communication.

Gentlemen, the paper is before us formally, and you will
take action as you think best. We find that the paper has
been signed by Dr. John Roy Williams, President, and Dr.

K. C. MEDICAL SOCIETY. 125

Edmund Harrison, Secretary of the Guilford County Medi-
cal Society. "What is your pleasure ?

De. J. P. Turner : As a member of the Guilford County
Medical Society, who sends this message to the State Society,
I would like to know whether it would be in order or not for
a member of that Society to appear before the Council.

Dk. Taylor : That is the pleasure of the Council. I am
open to a motion.

Dr. K:^ox : I move that all the members of the Guilford
County Medical Society be invited to make any remarks on
this subject which seem to them proper. Our source of in-
formation lies in the Guilford County Medical Society. We
know nothing but rumor — hearsay — of ourselves we have no
knowledge. The only accurate, detailed knowledge that is
being talked about all over this Society is in the membership
of the Guilford County Medical Society. I move that the
chair request all members of the Guilford County Medical
Society, who so desire, to address this Council.

Dr. Stevejs's : I move that the Guilford County Medical
Society speak through one member.

Dr. Kxox: I do not accejDt that, unless it is broadened —
unless the Medical Society desires to speak through one mem-
ber. We should hear a matter of this kind with an open,
broad, dispassionate mind.

If it is acceptable to the Guilford County Medical Societ};
to put their sayings in the mouth of one man, it is all right ;
but if all the Guilford County Medical Society desire to
speak, if it take us twenty-four hours, we ought to hear it.

Dr. McBrayer: It certainly is with great reluctance
that I occupy the position that I do. However, I am not
"unwell today" at all — (laughter) — but I will offer an
amendment to Dr. Knox's motion, and in doing so I will state.
so far as I am individually concerned, if we have to hear the

126 FIFTY-FIFTH ANNUAL SESSION

sixty-three members of the Guilford Comity Medical Society,
I have no objection to hearing the other five gentlemen who
are j^resent in this room, and I do not exclude anybody before
the Council meeting to make any remarks.

I therefore amend the motion of Dr. Knox by saying we
will hear any one who has anything to offer on the subject.

De. Knox : I made a motion to hear any member of the
Guilford County ^Medical Society in regard to this matter.
An amendment was made to limit anything said by the
Guilford County Society to one member. There were two
members of the Board of Councilors who did not know
what my motion was. Accidentally and incidentally, with-
out intending not to pay attention, two gentlemen didn't hear
the motion. I desire to repeat my motion.

De. Tayloe: Your motion has a second. I said the
amendment had none.

De. Knox: With your permission I will restate my mo-
tion, on the distinct ground that one member of the Board uf
Councilors told me that he did not hear what my motion
was. If the Guilford County Medical Society desires to
make one only of its members spokesman, and no one else, it
is satisfactory to the Board of Councilors. If, however, the
Guilford Medical Society does not so desire to limit it-
speech to the mouth of one man, I th.ink we ought to hear
anything that any member of that Society desires to sa;^.
That is our only source of information.

In investigating a thing of this kind, it is our duty to pro-
ceed in an orderly manner. It is our duty to have all of the
information obtainable, and unless the Guilford Countv
Medical Society especially desires to limit its speech to the
mouth of one man, we should exclude them alL

De. Tayloe: Is there any discussion on the motion of
Dr. Knox?

The question is that we shall hear any or all communica-

IS". C. MEDICAL SOCIETY. 127

• tions from the Guilford County Medical Society iu support
of the resolutions presented to the State Society. Those
favoring this motion will &a.y "Aye." Those opposed, '']^fo."

Dk. Kxox: I believe that does not correctly state my
motion. My motion was, "that the Board of Councilors
hear from the membership of the Guilford County Medical
Society in this matter ; that if the Guilford County Medical
Society desires to limit what it has to say to the mouth ot
one member, it is acceptable to the Board. If, on the con-
trary, the Guilford County Medical Society desires that its
several menibers shall speak, the Board will hear them."

Dk. Taylor: You have heard the motion of Dr. Knox.
Those favoring it will say ''Aye." Those opposed, '"No." The
motion prevails.

I think I represent the Council in asking the Guilford
County Medical Society for each man to speak on a different
subject and not reiterate what is to be said, for it would take
some time to go over and over again.

Dr. McBrayer : Before we go further with this, sir, T
would just like to ask the Chairman, or the Council, to rule
upon one point. So far as I am concerned — I am not very fa-
miliar with the laws that govern this Council in its delibera-
tions— there is no reason why we should not proceed in any
manner that we may choose, and render any decision or any
verdict that we may choose ; but, sir, it seems to be a policy
in this land of freedom that no man shall be convicted of any
crime or misdemeanor until he has first had an opportunity
to meet his accusers face to face, and to hear the charge that
is preferred against him, and have an opportunity to answer
thereto — if any answer he has. That holds true in all our
courts of equity, as I am informed. If a suit is instituted
against a gentleman, it must first start in the court, and he
must be notified that such and such charges are preferred
against him, and that he has so many days in which to demur
or answer to the charges ; and if he is arrested on a high

128 FIFTY-FIFTH ANNUAL SESSION

misdemeanor or felony, he may be placed in jail to await
his trial, but they can not try that man in his absence. If
he flees the .State, they can not convict him of murder until
he is brought face to face with his accusers and had a chance
to hear the evidence upon the charges and make an answer
thereto.

jSTow, sir, if this Council desires to proceed, I shall not
interpose any objection, but I should like to know if we are
to proceed in this matter without the gentleman against whom
these charges are made being given an invitation to be
present and given an opportunity to explain hi^nself.

Dk. Taylor: I rule that the Council sit as a committee,
and the action of the Council will be governed by the pleasure
of the majority of the Council. We have no precedent or
written rules, and we will be governed by the pleasure of
those present.

Dk. Knox: Mr. President: It occurs to me to ask if Dr.
Register, the editor of the Charlotte Medical Journal, has
been officially notified by the Guilford County Medical So-
ciety that this matter was to be brought up. I think it
proper that the members of the Guilford County Medical
Society should be asked to state whether or not due notifica-
tion has been given to Dr. Register that this matter would
come before the Society, or any part of it.

Dr. Edmund Harrison: Mr. President: No notice has
been given Dr. Register.

Dr. Harper: I think it would not be right to go ahead
and try a man in his absence. I think the editor should be
notified, and if he is in the city I think it proper now that
the Council notify him of this proceeding, and that he be re-
quested to come before this Council at a subsequent meeting.

Dr. Taylor: The Council is open to hear the Guil-
ford County Medical Society, through any representative or
those who care to speak, under the resolutions of Dr. Knox.

jst. c. medical society. 129

Dr. Haepek : If you will allow me I will read section 7
of the Constitution : "A man who is guilty of any offense — "

Dr. Knox: That isn't the authorized Constitution of
the Medical Society of Xorth Carolina. I hold in my hand
a copy of the original.

Dr. Laughinghouse : Mr. Chairman: I move that the
Secretary of the Xorth Carolina Medical Society be invited
to read the original. We do not know which copy is correct.

Seconded by Dr. McBeayer.

Dr. Taylor : It is ruled that the Secretary of the State
Society shall read this rule.

Dr. Knox: The point is made in an undertone, and I
think we should ask the Secretary of the State Society to state
whether the copy that I hand him is the Constitution of the
Medical Society of the State of J^orth Carolina.

Dr. Stanton: It is on the first page. (Secretary reads) :
"Medical Society of the State of North Carolina," etc. "Offi-
cers and Committee. 1903 edition."

"Medical Society of the State of iSTorth Carolina, officers
and committee for 1904."

"At the 49th annual session, 1902 ; the address of the Presi-
dent, Dr. Robert S. Young, contained the following:"

Dr. Taylor: The Chair rules that that is unnecessary.
"We will take the Secretary's statement.

Dr. Knox : Our Secretary that was during the year when
that Constitution was adopted is our present President, and
had been the efficient Secretary for years. I request that the
President of the Board of Councilors hand that paper to the
President of the North Carolina Medical Society and ask
him if he is satisfied that that is the authorized Constitution
of the Medical Society of the State of North Carolina, and
that this Council take his opinion of it as to its authority,
because he was then their Secretary.
9

130 riFTY-FIFTH ANNUAL SESSION

Dr. Tayloe: The Chair has understood the Council to
ask the Secretary to give his testimony, but if it is their pleas-
ure we will ask the President also.

Dk. Knox: I asked that because the present Secretary
was not the Secretary when this was adopted. The present
President of the North Carolina Medical Society was and had
been for years the efficient Secretary of the North Carolina
State Medical Society.

Dr. McBrayer: Mr. Chairman: May I be heard? I
do not like to quibble over small matters, sir. I really beg
your pardon for dabbling in this matter, but the point was
raised that the Constitution and By-laws as presented there
was not the correct copy, and if I remember the proceedings
this morning a motion has been made in the general session,
and carried without opposition, that a committee be ap-
pointed to edit this thing and make it as nearly correct as
possible, and I am willing to take your word, I am willing to
take the Secretary's word, I am willing to take the Presi-
dent's word, or most any one else's ; but the point was made
that this copy was not correct, and there is no evidence what-
ever, except this printing in cold type — there is no evidence
whatever that that is the Constitution of the Medical Society
of the State of North Carolina at all. It is not signed by the
officers, has not the seal of the Society upon it, and there is
nothing except some printed matter upon this page and prol)-
ably some other printed matter referring to the Medical So-
ciety of the State of North Carolina. Now, sir, I am going
to accept what the President of the Society or anybody else
says.

Dr. Taylor: The Chair rules that we will take the evi-
dence of the present President, and will aiot have further
discussion on the Constitution.

Dr. Knox: I do not object to the Secretary of the Society
putting the seal of the State Society upon that.

(The paper in question was here shown to the President
of the State Society for his opinion as to its legality.)

X. C. MEDICAL SOCIETY. 131

The Pkeside:xt: Mr. Chairman: My impression is
that this is a copy of the Constitution adopted at the 1903
session of the State Medical Society.

De. Kxox : I would ask the President if he is willing to
say that that is a correct copy ?

The Pkesidei^t : To the best of my knowledge and belief.

Dr. Kxox: To prevent absolutely any question about it
I ask that the Secretary be requested to put the seal of the
N'orth Carolina State Medical Society upon it.

Dr. McBrayer: I wish to make the point that the Coun-
cil has no right to instruct the Secretary of the State Medical
Society of N'orth Carolina to affix his signature and seal to a
document of any kind certifying if it is correct or not.

Dr. Kxox : I simply asked him if he was willing to put
his seal upon it.

Dr. Laughinghouse : It strikes me that this is all en-
tirely unnecessary. My motion was that the Secretary of the
'North Carolina Medical Society ^read from the official copy
of the North Carolina Medical Society the portion desired
by the gentleman. I take it for granted that the [N'orth Caro-
lina Medical Society is in possession of the official copy, and
if that official copy is produced we will get over this dilemma.

Dr. Taylor: The Chair rules that the Council will
proceed under this pamphlet as the Constitution of the State
Society, mark it as such, and if there is a difference it will
be a subject of appeal.

Dr. Taylor : The Council will proceed with the business,
and is open to a communication from the Guilford County
Medical Society.

Dr. Laughinghouse : BIr. Chairman: I move that the
Secretary read section 7, as was embodied in the motion
which was carried some minutes ago.

132 riFTY-riFTH ANNUAL SESSION

Dr. Taylor: The Secretary is instructed to read section
7 without further discussion. By-laws, ch. 1, sec. 7.
(The section referred to read by the Secretary.)

Dr. Taylor: The Chair rules that this section does not
refer to the present deliberations.

Dr. John Koy Williams: Mr. Chairman: In refer-
ence to the editor of the Charlotte Medical Journal having
been officially notified as required by the By-laws of this So-
ciety, I beg leave to submit to you honorable gentlemen that
yesterday morning I came into this assembly and I arose to
a question of personal privilege —

Dr. Laughinghouse : Mr. Chairn^an: I rise to a point
of order. According to the section read just now we have
absolutely nothing before us. The only legal way in which
we can get anything before us is to have it come to the Secre-
tary of the ISTorth Carolina Medical Society in the form of a
written communication, that written communication is to
be handed to us by the Secretary of the North Carolina Medi-
cal Society; hence we have absolutely nothing before the
house, and we can not act until we have such communication,
coming through the Secretary of the ISTorth Carolina Medical
Society. Therefore I say that all evidence and all arguments
are out of order until we get such a resolution, delivered to
us in a proper manner.

Dr. Williams: That is the point I desire to make.

Dr. Taylor : The Chair is pleased to make a decision on
this point. It is the opinion of the Chair that the Council
holds the position to hear any complaints, and if there is suffi-
cient evidence of any dereliction on the part of any member
to put that before the censors.

Dr. Stevens : I would suggest that we turn to the Board
of Censors. If those are the rules that govern us we can not
do anything. We can not override all our precedents and
rules in the Society.

A". C. MEDICAL SOCIETY. 133

Dk. Williams : I beg leave to show that the charges have
been submitted to the Secretary of the ^orth Carolina State
Medical Society.

Dr. Steven's : They have not been submitted for a suffi-
cient length of time, and we can not change the Constitution
at our will.

Dr. Harper: il/r. President: I move, in view of the
fact that we have nothing before us that we now adjourn.

Dr. Taylor : The Chair is forced to hold that the Board
of Councilors is the Board of Censors, and is here to hear
any complaints.

Dr. Kxox: Mr. President: I desire to make this state-
ment, much as I regret to make it : It is absolutely essential
that a Board of Censors or a Board of Councilors shall know
what it is doing. It is essential that this Board should know
what the law that governs it is. It is a fact that during the
time the Secretary of the State Medical Society was reading
sec. 7, ch. 1 of the By-laws, several of the Councilors were
talking and did not hear it. I ask that the Chair request the
Secretary to again read sec. 7 of ch. 1 of the By-laws, and
that the Chair keep order in the Board of Councilors while
it is being read.

(Dr. Laughinghouse here reads the section referred to from
the Transactions for 1907.)

Dr. Knox : I ask that the gentleman read from the recog-
nized Constitution and By-laws.

Dr. Laughinghouse : I want to say that this is a copy
(picking up the pamphlet referred to) sworn and certified to
by the President and Secretary (laughter) of the Medical
Society of the State of North Carolina.

(The section is here read.)

Dr. Laughinghouse: Now, Mr. President, my idea is
that w^e have absolutely nothing before us as a Board of Cen-

134 FIFTY-FIFTH AA^NUAL SESSION

sors, and we can not liave anything as a Board of Censors
until that thing comes to us through the Secretary of the
Xorth Carolina State Medical Society, and comes in writing.

Dr. Williams: Mr, Chairman: I wish to show that
this has come through the Secretary of the North Carolina
Medical Society.

Dr. Taylor: The Chair was going to ask of our Secre-
tary if such was the case. Has this come to us through the
Secretary of the State Society ?

Dr. Williams: I presented it to the liorth Carolina
State Medical Society.

Dr. Knox: I move that Dr. Williams he heard in any
statement he wishes to make in regard to the legal and formal
presentation which he made to the Secretary of the North
Carolina State Medical Society.

Dr. Williams: Mr. President and Me7nhers of the
Council: I arose yesterday morning to a question of per-
sonal privilege. According to the Constitution and By-laws
this Society is governed by rules which I hold in my hand —

Dr. McBrayer: I rise to a point of order.

Dr. Taylor : The Chair will hear Dr. McBrayer.

Dr. McBrayer: I have no objection to hearing any one,
nor of hearing Dr. Williams; but I do insist, sir, that any
one coming before this Society shall speak in proper order
and to the point.

I wish to make the point, sir, that we have nothing what-
ever to do with any fuss or any contention. I beg pardon
for the word ''fuss." With any contention between the Guil-
ford County Medical Society or between its officers and the
officers of the Medical Society of the State of North Carolina.

I malce the point, sir, that we have not received any charge
through the Secretary of the Medical Society of the State
of North Carolina, as is provided and required in the Consti-

X. C. MEDICAL SOCIETY. 135

tiiti<:)n and By-laws of the Society, and therefore we can not
consider anything. I make that point, and then I will make
a motion as soon as you rule on it.

Dr. Taylor : The Chair rules that we have had no com-
munication in its regular channel and we shall hear the state-
ment of Dr. Williams on that point, as to whether it has been
started to the Council through the Secretary of the Society.

Dk. Williams: Koberts' Kules read: ''Questions relat-
ing to the rights and privileges —

Dr. Laughii^ghouse : I rise to a point of order.

(Cries of "Do^^■n ! down!" from the members of the bo-
ciety. )

Dr. K^^ox : I ask that the Chair request the members of
the Society, outside of the Board of Councilors, to speak with
respect to the Council. The Chair w411 not be governed by
any one outside of the Council. It desires to treat everybody
standing within its hearing with proper respect, and it re-
spectfully asks for similar consideration and we should not
be interrupted with calls of "Sit down ! Sit down !" We will
not "sit down" until we do our full duty. (Applause.)

Dr. LArGHixGHOusE : 2Ir. Chairman: I wish to say
the object of my contention is a conscientious object. I take
it for granted that the members of the Medical Society of
the State of Xorth Carolina desire to have a thing done prop-
erly, honestly, squarely and disinterestedly. I furthermore
believe that the backbone and common sense and conscientious
intelligence of the Society will come down in disapprobation
upon any committee, any individual, any Board of Censors
who in a lax and unconstitutional manner performs their
duty. I believe, sincerely and honestly, that we are making
a mistake to receive any oral communications before this
Board until there is a charge brought before something or
somebody in a constitutional and a legal manner. I contend,
therefore, that Dr. Williams nor doctor anybody else has any

136 FIFTY-FIFTH AXXCAL SESSION

right to appear before this Board orally until such a com-
munication is brought to us in a proper manner. As it is we
have absolutely nothing to act upon. We are absolutely with-
out business. We are sitting here waiting and asking that
the purpose of this Convention be brought before this Board
of Councilors in a legal and a proper manner, and I do not
think that Dr. Williams nor any one else has the right to
come and suggest to us anything out of Roberts' Rules ol
Order, the ten commandments, or anything else. It is a ques-
tion of plain, common-sense business that I am contending
for; and I want it furthermore understood that there is no
personal feeling in this matter, so far as I am concerned. 1
feel as kindly toward the Guilford County Medical Society
as I possibly can, and I have no reason to feel otherwise. I
have no unkind feeling towards any man, either prosecutor
or prosecuted ; I have no feeling in this thing, except one
point: I am deeply interested in the E'orth Carolina Medical
Society. My duty is going to be done to that regardless of
any member or any set of men.

Dr. Taylor: I will hear the Council on Dr. Laughing-
house's point of order.

Dr. Knox: Mr. President: I made the point just now,
and I rise for that reason, that Dr. Williams, having stated
that he had made the communication to our Secretary, had
the right to state that he had made it in the proper way. I
realize from what Dr. Laughinghouse has said that that was
not the proper view. This Board has no right to take any
step until the proper step has been taken, through regulai
procedure, and the Secretary has transmitted to us any state-
ment or grievance that has come to him or to anybody else.
The Secretary has not made such a statement, and the gentle-
ment of the Guilford County Medical Society, in spite of
my views just now, have no right to make any complaint until
this Council has a communication from the Secretary of the
Medical Society of the State of ISTorth Carolina, and this

X. C. MEDICAL SOCIETY. 137

Board has no such comiiuinieation. We must proceed in an
orderly way. I move that the whole thing be referred back
to the Guilford County Medical Society that the thing be put
in proper form.

Dr. Laughixghouse : In speaking on that motion I
would say that the Guilford County Medical Society, as long
as they have those communications written, present them
here and now to the Secretary of the State Medical Society,
and the Society present them to the Board of Censors. It

can be done now, and settled now.

De, Taylor : The question is on the motion of Dr. Knox,
that the matter be referred back to the Guilford County
Medical Society, and that no action be taken by the Council
until we have a communication from them in proper form.

Dr. Knox: Before the vote is put I desire to emphasize
the suggestion made by my friend. Dr. Laughinghouse, that
we suggest to the Guilford County Medical Society that they
immediately make their presentation to the Secretary of the
ISTorth Carolina Medical Society, and that he in turn turn it
over to us.

Dr. McBrayer : I don't want to tell the Guilford County
Medical Society what they ought or ought not to do. Let's
not tell them what to do. They are a nice set of clever, able,
gentlemen. (Applause.)

Dr. Laugiiia'ghouse : It was simply a suggestion. They
have their charges completed and it is an easy matter to turn
their charges over to the Secretary.

Dr. Taylor : The question is on the motion of Dr. Knox,
that the matter be referred back to the Guilford County ]\Ied-
ical Society. (Motion carried.)

Dr. Taylor : The "Ayes" have it. The matter is re-
ferred back to the Secretary of the Guilford County Medical
Society.

13S FIFTY-FIFTH ANNUAL SESSION

Dr. McBkayek: Mr. President: I move that we ad-
journ, subject to the call of the Chairman. (Motion carried.)

President of the Society^ Dr. Way: The session of
the Medical Society of the State of North Carolina will now
be in order.

Dr. Bahnson: If I may be permitted to ask a question
I should like to be answered before these gentlemen leave the
hall.

As I understand this procedure the Guilford County Medi-
cal Society, for whom I hiive not only respect but honor, the
Guilford County ]Medical Society has been deliberately re-
fused a hearing of a communication in the open meetings of
the Society several times. Perhaps it was inopportune. Cer-
tainly they have been treated, in my opinion, discourteously.

My motion this morning was after the Chair ruled that
they could not be heard except before the Board of Censors,
my motion was that the Board of Councilors sit now, not to
decide the question of guilt or innocence, but to show the
courtesy to the Guilford County Medical Society that it has
been denied, again and again, a hearing before this Society.
I only wish to know if that is the proper understanding of the
case ?

Dr. Taylor: Mr. President: The Board of Censors
met in accordance with instructions of the Society, and on
constitutional grounds they referred the whole matter back to
the Guilford County Medical Society for its constitutional
course. The Board of Councilors has adjourned, and report
back to the Society that this communication has been re-
ferred to the Guilford County Medical Society. The Board
is adjourned, at the call of the Chair, and will reconvene at
fifteen minutes before twelve to hear any communication
coming in the regular way.

Dr. Laughinghouse : Mr. President: In reply to my
ffood friend Dr. Bahnson, for whom I have an afPection and a

X. C. MEDICAL SOCIETY. 139

respect and a veneration which comes to me by inheritance,
I have to sav this: Looking from this proposition from up
a tree I think there are two sides to the question. Because
a resolution or because a request is refused in open Society
does not necessarily mean that that request or that resolution,
or the individual, or set of individuals who presented the
same, have been treated discourteously.

The laws of i^orth Carolina prescribe that the Board of
Medical Examiners shall be elected on Wednesday, and that
the election shall begin at 10 o'clock. This resolution was
brought in after the Board of Medical Examiners' election
was gone into. The President of this Society, I imagine,,
with his usual forethought and his caution, and the interest
of the Society as a whole at heart, realized that when this
resolution was brought in it would take up time ad infinitum,
and that the Board of Medical Examiners would not be
elected according to law if this matter should take precedence
of the matter then being executed ; hence he very wisely re-
fused the hearing of that resolution.

That resolution was brought up again before the conjoint
session of the Board of Health, and Dr. Thomas, who was
President of the Board of Health, and had no more to do with
executing the office of President of the Xorth Carolina Medi-
cal Society than I had, could not grant that request.

So, after all, to a man who has gone into the pros and cons
of the proposition, it looks like the Society has not treated
nor has the President treated any mem.ber discourteously.

The Pkesidext: Gentlemen: The Chair rules that
having recessed for an open session of the Council, which
open session having been held and the general meeting now
having resumed, there is nothing now before the general meet-
ing, and I call now for the regular program, which is the paper
of Dr. A. B. Croom, of Maxton. on ''Obstetrical Work from
the Standpoint of the General Practitioner."

"The Eelation of the Laboratory to the General Prac;
titioner," Dr. Watson S. Eankin, Wake Eorest.

140 FIFTY-FIFTH AXNUAL SESSION

De. Fletcher: Mr. Chairman: As a general prac-
titioner for many years I desire to say, sir, that this is the
most practical and sensible paper that I have ever heard on
this subject.

Dk. Taylor: Mr. President: According to the request
of the Councilors I was to call the session together again in
fifteen minutes after adjournment, and the Council being
ready for business I will ask their assembly.

If it is not convenient to the house to give us the room we
will meet anywhere that the Council suggests.

The President : You have heard the request of the
Chairman of the Council. Is it your pleasure to grant it?
The Chair is ready to entertain a motion either way. Do I
hear a motion that the Council be granted the privileges of
the floor for a few minutes ?

De. McBeayee: Mr. President: As I understood, sir,
on a previous motion we were to assemble here in the pres-
ence of this Society, and as this is a continuation of the meet-
ing, I take it, it seems to me it is unnecessary for a motion
to be entertained. I should be pleased to have all of the
gentlemen j)resent who are in the hall.

The Peesident: Gentlemen: Without objection, then,
the Council will assemble for a few minutes' session in the
hall, and, declaring a recess of the Society, I tender the gavel
to the President of the Council, Dr. Taylor.

Dr. Julian : I desire to announce that the State Society
for the Prevention of Tuberculosis will meet in the lobby of
the Zinzendorf at half-past 12 o'clock.

Dr. Taylor: The Council will please come to order.
According to request the Council is again called to consider a
communication from the Guilford County Medical Society,
which, through the Secretary of the State Society, has come
before us. The matter awaits your pleasure.

N. C. MEDICAL SOCIETY. l-tl

Dr. Knox: Do I understand, Mr. President — I wish to
know if I am correct — that the Secretary of the State Medical
Society of the State of North Carolina has presented this
communication from the Society to this Council ?

Dr. Taylor : That is what I desire to state.

Dr. Knox: I desire to ask that this Council hear from
the Guilford County Medical Society bearing upon this ques-
tion.

Dr. Laughinghouse : Mr. Chairman: I will second
that motion, so as to put it before the house, and then dis-
cuss it.

Dr. Knox : My motion is — if it was not put — I make an-
other motion : I move that the Board of Councilors of the Med-
ical Society of the State of Xorth Carolina will be glad to
hear from any member of the Guilford County Medical So-
ciety in reference to the communication which has now come,
in an orderly way, to this Board through the Secretary of
the State Medical Society.

Motion seconded by Dr. Smith.

Dr. Laughinghouse: In my opinion that motion is en-
tirely out of order. We are not in a position to receive testi-
mony, either pro or con, until the accused has been enlight-
ened as to his charge, given the specified time allowed by the
Constitution and By-laws of the Medical Society of the State
of North Carolina, and then the Guilford County Medical
Society can come to us with all the evidence it sees fit to give,
but that evidence to-day is absolutely out of order. It isn't
in accordance with the rules prescribed by our Society ; hence
I am opposed to that motion.

Dr. Knox: I desire a moment to read this communica-
tion to see if I am right in my impression. The charges have
to be made in writing, and that is what is done here now,
and if you will allow me I will take one minute to read the
communication.

142 FIFTY-FIFTH AN^^'UAL SESSION

(Here reads the communication referred to, which was
jDresented at the first meeting of the Council.)

I understand the point of order to be made by Dr. Laugh-
inghouse that the Guilford County Medical Society has not
yet presented in order any definite charges. Dr. Laughing-
house makes the point of order that they are not charges in
writing, in accordance with the law, from the Guilford County
Medical Society. We want to give these gentlemen an op-
portunity to state fairly what they want to state, and if it is
considered that that letter is not in the nature of charges, and
these gentlemen under a misapprehension hare conceived
that letter to be charges, they have due notice now that they
have not presented, in accordance w^ith the Constitution, writ-
ten charges against anybody. I don't think the point well
taken. I think that letter constitutes charges. But we must
comply with the letter and spirit of the law. That we are
going to do regardless of any other person's opinion ; but, in
my view, that letter constitutes charges. I think it does, but
one of the members of the Board of Councilors makes the
point that there are no charges before this body in conformity
with the Constitution. I think the gentlemen from the Guil-
ford County Medical Society have the right to understand
that they are misunderstood by any members of the Council,
and that if they desire to make any corrections they should
be given a chance to do so.

Dr. Laughinghouse: Dr. Knox misconstrues my point
of order. To make it plain, as I understand it, the Guilford
County Medical Society has presented to the Secretary of the
State Medical Society charges properly made in writing.
These charges have been brought to the Secretary of the
Board of Censors. The Secretary of the Board of Censors
has brought this to the attention of the Board. As I under-
stand it, this Board realizes that the Guilford County Medical
Society has acted in conformity with the law of the Consti-
tution. I understand it as such.

N. C. MEDICAL SOCIETY, 14:3

The point I am trying to make is that we have received
this charge. In accordance with the Bv-laws the Board of
Censors now tenders a copy of this charge to the accused. The
accused then has a certain number of days — I think ten — in
which to prepare rebuttal evidence to disprove the charges
brought against him. The Board of Censors at this sitting,
according to the Constitution, can not be open to any evidence,
pro or con. As I take it, this Board of Censors, after an al-
lotted time, after the accused has been given a copy of the
charges brought against him, this Board of Censors has got
to meet somewhere in the State of ISTorth Carolina within the
prescribed time and settle this matter. We can not settle it
to-day other than the charges are absolutely unconsiitutional.

Dr. Knox: I understood the gentleman to say that he
didn't understand the charges had been specifically presented
in writing.

Dr. Laughinghouse : I consider the charges specifically
presented in writing, excepting one point. That is, that the
Charlotte Medical Journal appears to be on trial, and the
Charlotte Medical Journal has not paid its dues to the So-
ciety, and therefore is not a member of the Society.

Dr. Kis'Ox: I desire to correct the gentleman. Dr. E. C.
Register is the gentleman and has paid his dues.

Dr. Laughixghouse : Dr. Register's name does not ap-
pear on it, and I would suggest that the Guilford County
Medical Society put his name in the charges.

Dr. Kxox: Dr. E. C. Register is the editor.

Dr. Laugh ixghotjse : We are not supposed to know who
the editor is. He may be the angel Gabriel. We are not sup-
posed to know the editor of any journal. Dr. Register's name
ought to be put in there, and I move that this be returned
and this little change made. The only thing I want is consti-
tutionalitv.

144 FIFTY-FIFTH ANNUAL SESSION

De. Williams: I beg to say that the Guilford County
Medical Society has no desire to put Dr. Register's name in
there, and that it begs to call to the attention of the gentle-
men of this Society who do not know who the editor of the
Charlotte Medical Journal is, who he is.

De. Sikes : I believe I see a point to enable us to facili-
tate matters. This County Society, as I understand, do not
want to present charges if they can be avoided. They have
asked this Board of Councilors to hear them and then, if it is
their decision that they are justified in these charges, then
they propose to present charges and have them come in the
right way. They are asking your opinion as to the advisa-
bility as to whether they shall present those charges or not.

De. Knox: It seems to me if that is the course that the
Guilford County Medical Society wishes to pursue that they
should ask the advice of private individuals. The Board of
Councilors can not give advice on matters to come before
them in the future. If they do they put themselves in the
way of working unfairly toward matters to come before them
in the future. If you go to a member of the Board of Cen-
sors when they are not in session or, preferably, some ju-
dicially-minded member of the State Society, and ask his per-
sonal advice and opinion, then you are on the right track;
but for a member of the Board of Censors to advise a mem-
ber of the ISTorth Carolina State Medical Society whether they
shall or shall not bring forward certain charges, it seems to
me to be putting the Council in an awkward position.

De. John Roy Williams : The Board of Guilford
County Commissioners desire to state that the charges are
in the attached cards. They speak for themselves.

De. Weavee: Mr. Chairman: May I speak two words?
You gentlemen are sitting here as a grand jury. If there
is any evidence against the gentleman I would suggest that
you bring in the verdict ; otherwise that you set the trial to
be had at a future time.

X. C. MEDICAL SOCIETY. 145

Dr. Beall: The trouble, Mr. President, with this mat-
ter, as it seems to us, is that you are endeavoring to prejudge
the ease before the evidence is before you. Xow there are a
number of points bearing exactly upon the various questions
that you are arguing that we think we could satisfactorily ex-
plain if we had the opportunity to bring the matter before
your Board. We thought, under the resolution with which
you are constituted, that you were to sit and hear this case
regardless of any judginent you were to render or whether you
should decide to render any judginent or not, and the So-
ciety of Guilford County has been criticised for various omis-
sions: First, that we did not give Dr. Register due notice
before this matter was brought before this Society. Tech-
nically that is correct. The Charlotte Medical Journal
reached Greensboro on the 12th of June. In that issue we
found a card advertising a fake institution, recognized not
only in Guilford County as a fake institution, but one that is
known all over the State as the attention of the public has
been called to it as one of the grossest impositions that exists
in Xorth Carolina. If Ave had given Dr. Register official
notice he could and would have come before this Society and
claimed that he did not have the regulation ten days notice,
which Avas in the nature of the case impossible to gi^^e him.
That being the case, and the matter going off from before this
Society, that card could continue to run in the Charlotte
Medical Journal for twelve months, without any protest from
any members of the I^orth Carolina Medical Society, and
Ave hold that the publication of that card is an endorsement
of the Medical Society of IsTorth Carolina. It is the only
medical journal published in the State. It is presumed to ad-
A^ertise legitimate institutions, and there is nothing on the
card to indicate that anything about it is unethical.

We felt, as the parties most aggrieved by that publication,
that it was due the Medical Society of ISTorth Carolina to

146 riFTY-FIFTH ANNUAL SESSION

have their attention called to a thing that we consider a breach
of conrtesy and an insult.

Now, it has been alleged that Dr. Register allowed this
card to enter his columns ignorantly; that he knew nothing
about the man or the character of the institution advertised.

A few years ago the Board of Examiners of iSTorth Carolina
prosecuted through the courts this Dr. Biggs for practicing
medicine without a license. He was convicted in the Guil-
ford County Superior Court, and upon appeal to the Supreme
Court the verdict was reversed upon the ground that Dr.
Biggs, who advertised himself as a drug healer, was not a
physician within the meaning of the act, and he turned back
to Greensboro and set up this institution, with larger fimds,
and has been advertising through the lay press continuously ;
but this is the first time in the history of medical literature
so far as I know, certainly in North Carolina, that an out-
rageous quack institution has been allowed to publish a card
in a medical journal of North Carolina or in the United
States, so far as I know or am informed.

Now, as to the character of the man and of the institu-
tion, the facts are patent to any one who seeks information,
and I hold and the Guilford County Medical Society holds
(for which I am speaking) that the only medical journal in
North Carolina has no right to advertise to the public an in-
stitution that is opposing every physician in the State, that
belittles the medical profession, that says to his neighbors
when they come to him, ''Your disease is due to the fact tliat
you have been drugged to death. All that you need is to
come into my institution and take my treatment, get this
medicine that the doctors have been pouring into your stom-
ach out of your system, and you will be well."

The effort of the Guilford County Medical Society since
the Society of North Carolina met has been to bring these
facts, which you are now gracefully permitting me and this
Society to present to you, before you as a body, and we feel
that if we, the largest County Society in North Carolina,

N. C. MEDICAL SOCIETY. 147

and in that respect an important component part of this So-
ciety, is debarred from stating onr position before this So-
ciety that we have had inflicted upon ns a grievous wrong,
and not being content to lie still under that wrong we would
feel necessarily obliged to resort to some other measure to
bring before the public and before the profession the facts
that we had in our possession ; but we propose and have pro-
posed all along to act decently and in order, and we wanted
to bring this matter before the Society for their information
and action.

]^ow, so far as we are personally concerned we do not care
particularly about Dr. Biggs' sanitarium. He has been with
us about ten years and he says that he has about reaped that
field and that this year he is going to move his sanitarium to
Asheville (laughter and applause), and when he gets that far
west we will be co,ntent and will leave it to them to wrestle
with.

De. Laughinghouse : The point I am trying to bring be-
fore you is, according to the rules of the Society, that we
have received these charges. The next step of the Board of
Censors is to immediately furnish a copy to the accused and
to the Chairman of the Board of Censors. The Board of Cen-
sors shall investigate the charges on their merits, but no ac-
tion shall be taken before giving the accused and accusers an
opportunity to be heard; and on those grounds I feel that
the proper thing for the Board of Censors to do is to instruct
its secretary to send a copy of this charge to the Medical
Journal, then the Board of Censors should decide upon some
day to meet and hear the evidence, pro and con, concerning
this proposition. It is the only legal way we can attend to it.
Therefore I move that the Secretary be instructed to send a
copy to the Charlotte Medical Journal of the charges brought
against it to-day. Motion seconded.

Dr. Edmund Harrisox: I would just like to say that
now that we have an elective council what body would it go
before ?

148 FIFTY-FIFTH ANNUAL SESSION

Dk. Taylor: The Council sitting now is not informed
upon the ruling, but my opinion is that it is before the regu-
lar Board of the Censors,

The question, gentlemen, is the motion of Dr. Laughing-
house that a copy of this resolution be sent to the Charlotte
Medical Journal, as prescribed by the law and the Constitu-
tion.

De. Laughinghouse : It is moved that a copy of the
charges brought against the Charlotte Medical Journal by
the Guilford County Medical Society be sent the said Journal.
Motion carried.

Dr. Laughinghouse: Mr. Chairman: It seems that
we have performed our duty up to date at any rate, and 1
want to take this opportunity of saying that I sincerely hope
that this misfortune, for it is a misfortune, will not affect
the ISTorth Carolina Medical Society in any way.

The Guilford County Medical Society has a perfect right
and ought to bring such things to the notice of the Society.
In the Guilford County Medical Society there are men who
will do as much for the Xorth Carolina Medical Society as
any number of men in the whole State. They are thoroughly
conscientious and believe they are doing what they ought
to do.

I trust that any suspicion of foul play on the part of the
Society or the Censors or the Guilford County Medical So-
ciety will be cast from the mind of every man. Each and
every one of us were doing our duty as we saw it. If we
differed that was because of our individuality. I trust that
this thing will slip out from the memory of each and every
one of us without leaving any corns or other painful spots.
For my part I feel that we, as members of this Society, should
take the seeds that have been given to us and grow them into
flowers. We should put those flowers in an environment that
will prove to be a soil so fertile that the flowers will be
brought to those who come after us in the form of good, ripe

N. C. MEDICAL SOCIETY. 149

fruit. So far as I am concerned I want to be looked upon as
a grain of sand that makes up the mortar to stop up the
cracks of the whole of the JSTorth Carolina Medical Society. I
want to be known as one of the bricks that go to fill up the
pillars that hold up, strong and well, this Society that has
done so much for us and for the whole United States.

Dr. Bahnson: Mr. President: On behalf of the So-
ciety I want to thank Dr. Laughinghouse for his very timely
and very hearty remarks. I acce}:)t them. I accept the hon-
est and genuine work of the Board of Censors, however con-
stituted, as an honest expression of opinion, and I wish now
to make a motion :

That the Medical Society of the State of IN'orth Carolina,
in regular meeting assembled, unanimously repudiate the
Charlotte Medical Journal, its nameless editor and all his
works as being totally unfit for the use of any self-respecting
physician of the State.

Dr : Mr. President: I desire to make the

motion that we adjourn to meet after dinner in a private
room.

Dr. Taylor: The question is on the motion that this
body shall adjourn, subject to the call of the Chair. Those
favoring it say "Aye." Those opposed, "No." The Council
is adjourned.

President of the Society^ Dr. Way: Gentlemen:
The general meeting of the Medical Society is now resumed.

Dr.. Bahnsok : I beg the Society's pardon and the Board
of Censors' pardon for bringing my motion in at an inoppor-
tune moment, and I brought my motion with the hope of
reconciling conflicting ideas. In view of the fact of the un-
ethical, unprofessional act of the conduct on the part of the
Charlotte Medical Journal, I desire to make the motion that
the Society of the State of N"orth Carolina do repudiate the
Charlotte Medical Journal, its nameless editor and all his

150 FIFTY-FirTH ANNUAL SESSION

works, as being totally unfit for the patronage of anj self-
respecting physician of the State.

Dr. John T. Burrus : I second that motion.

Dr. Laughinghouse : i¥r. President: In the name of
harmony, in the name of justice and in the name of square
dealing; I move that the motion be not carried. We do not
know whether the Charlotte Medical Journal has been guilty
of a misdemeanor with intent or not. This Society has not
as yet had brought before it any evidence from the Charlotte
Medical Journal that it has acted incorrectly, with knowl-
edge, with forethought and with intent. It may be that the
Charlotte Medical Journal inadvertently made this mistake.
The Charlotte Medical Journal is a journal that has the larg-
est circulation in the South. It goes to Georgia, South Caro-
lina, Texas, Mississippi; in fact, all over the South. The
duties incumbent upon the editors of the Medical Journal
are nothing like as small as one might think. How do we
know but what the Charlotte Medical Journal has some lay-
man who looks after the advertising department, and this lay-
man, absolutely ignorant of committing any crime, secured
the advertisement of this sanitarium without the knowledge
of the editors. If this is the case are we doing justice to the
Charlotte Medical Journal to repudiate it ? I ask that ques-
tion and sit down.

Dr. Weaver : As I understand it, sir, I do not think that
the Cliarlotte Medical Journal is the official organ of this
Society. Therefore, officially. I do not see how we can con-
demn it as a body, but individually we can repudiate as each
individual may see fit. Therefore I move that we lay this
motion on the table.

Dr. J. A. Turner: Mr. President: I want to ask the
question if it is not an insult that the editor of the Charlotte
Medical Journal is so derelict as to turn over the advertising
to a layman ? Have we a right to assume that the editor of
the Charlotte Medical Journal does not know that the Keeley
Institute of Greensboro is not an ethical institution ? That

X. C. MEDICAL SOCIETY. 151

it does not come within his right and diit}" to secure a man-
ager who will not advertise such things to a people who are
not supposed to know what is right or wrong along these lines ?
I refer to the people who wall patronize those institutions.

Dr. J. ]\I. Taylor: J/r. President: Whatever we may
think about the action of the editor of the Charlotte Medical
Journal in admitting this advertisement to its paper, w^e do
and should know that it is the property of a stock company,
and while we do repudiate this sort of thing we are about to
injure the property of an ethical company of physicians, and
it would be well to pause before we do it. I know that there
are in the Charlotte Medical Journal a number of physicians,
part owners of it, in the recent consolidation wuth the Caro-
lina Medical Journal and the Charlotte Medical Journal,
who are ethical and wish to be in order.

Dr. Knox : Whatever we may think of it, under other
circumstances, the editor of the Charlotte Medical Journal is
under charges referred to the Board of Censors. The Board
has adjourned in order to allow the orderly course of pro-
cedure. He is entitled — whatever he may have done — to the
orderly course of procedure, of a deliberate and judicial
course of procedure in order to defend himself. He is not
here. I think it would be highly improper, whatever may be
done after the investigation of the Board of Censors, to
adopt any such resolutions at this meeting. We must be fair
and square and true, and I know of no fairer man than Dr.
Bahnson. He means to do the right and just thing. In my
mind that is not the just thing. No matter if we know a
man to be a criminal he must be given an opportunity to clear
himself.

Dr. Laughinghouse : Mr. Chairman: In reply to Dr.
Turner, I simply give him a trite illustration. If I were
going to burn up a man's house I would do it after he was
condemned.

152 FirTY-FIFTH AISTNUAL SESSION

Dr. Weaver: I understood that this motion had been
tabled.

The President: It has been moved and seconded that
this motion of Dr. Bahnson be laid on the table.

Dr. Bahnson: Mr. President: That is imconstitn-
tional. My motion can be amended but not thrust aside for
some other motion. I wish to be heard before that amend-
ment is made. My motion is made and seconded and is regu-
larly before the house. ISTo other motion can come before the
house until that is disposed of.

The President : I will be very glad to have Dr. Bahnson
state his motion.

Dr. Bahnson : Again ?

The President : Yes, sir.

Dr. Bahnson: I move that the Medical Society of the
State of North Carolina, in regular session assembled, unani-
mously repudiate the Charlotte Medical Journal — if the gen-
tleman is anxious about this — shall I repeat it ?

The President : If you please, yes.

Dr. Bahnson : - — its nameless editor and all his works, as
being utterly unworthy the patronage of any self-respecting
physician in the State. And that was seconded, Mr. Chair-
n an, and I would like to say why I desire to have that motion
passed. I desire to reiterate, if any man needs more evidence
of guilt, it seems to me that he would have to have an angel
to enlighten his mind. The evidence is patent. So far as
the responsibility is concerned, which the gentleman has
touchingiy spoken of, the responsibility for the advertise-
ment, I never have heard of a bank director being excused
from his penalty because the cashier ran away with the
bank's funds ; neither have I heard of a man who was excused
because of his ignorance of the law or of a circumstance. So
far as the nameless editor of the Cliarlotte Medical Journal

N. C. MEDICAL SOCIETY. 153

is concerned he has had ample opportunity, in his varied and
long life, to know what the ethics of the xlssociation are. So
far as the gentlemen in the stock company are concerned
my sympathies go out to them. That is an additional in-
jury. Why this injury, damnable insult, crime against the
medical profession in Xorth Carolina has been spread all
over our land. The Charlotte Medical Journal has the big-
gest circulation in the State, and this abscess that he fosters
is spread all over our land, even upon our borders, and we
are to sit back while the nameless editor pleads the "baby
act!"

The Peesidext: Dr. Balinson: This resolution of
yours is a matter of great consequence, and I want to ask you
that it be reduced to writing before it is put to this body.
Will you kindly do so ?

Dr. Bahnsox: Yes, sir; at once.

Dk. Long: Mr. President: I have a motion.

The President raps for order.

De. Long: Mr. President:

The President : The Society will be in order.

De. Long: Mr. President, Gentlemen: Li the name of
the Medical Society I insist that I be heard.

The President: The Chair has called for the resolu-
tion of Dr. Bahnson, wdiich he is reducing to writing. Pend-
ing the answer to that call Dr. Bahnson has the floor, and
the Chair rules Dr. Long out of order.

De. Bahnson: I yield to Dr. Long, temporarily.
The Peesident: Dr. Long:

Dr. Long: I recognize the fact that the matter embodied
in Dr. Bahnson's motion is a very important thing, not only
for the Guilford County Medical Society but for the ISTorth
Carolina Medical Society, and I most earnestly desire that

154 FIFTY-FIFTH ANNUAL SESSION

what goes on record here shall not only be the right thing but
shall be just to all parties concerned; and with that spirit
and with that intent I desire to move a substitute for Dr.
Bahnson's motion, if I understand from the Chair that this
motion is before the house.

Dr. Knox: 2Ir. President: I can enlighten the gentle-
man. It is my conviction that Dr. Bahnson will modify his
original motion and put it before the house. If the gentle-
man will wait but a minute he will be able to make his sug-
gestion.

Dk. Bahnson: il/r. President: With the permission of
the gentleman who seconded me and the permission of the
gentlemen who so well supported me, I desire, because of the
fact that I was urged on by the earnestness of purpose, to
modify, to a certain extent, the motion that I made, and with
your permission I will read that instead of the other :

Resolved, That the Medical Society of the State of North Carolina,
in regular session assembled, unanimously agrees that if the Charlotte
Medical Journal does not at once withdraw all unethical advertisements,
and does not tender an ample apology, that the support of the Society
and its members be withdrawn.

Dr. Burrus: As being the member of this Society who
seconded the first motion I wish to arise to second this mo-
tion of Dr. Bahnson's, and to urge its passage.

The President: The resolutions are before you. What
is the pleasure of the Society? Is there any discussion de-
sired upon this resolution ?

The question is upon the adoption of the resolution as
read. Those favoring the adoption of the resolution will
signify it by saying "Aye." Those opposed, "No."

Dr. Knox: Xo. And I wish to explain that. I believe
if an investigation had been made by the Board of Censors
that that motion would be in order. It would have been
wiser to have withheld any such action until after the judg-
ment of the Board of Censors.

N. C. MEDICAL SOCIETY. 155

Dr. Jewett: Mr. President: As I understand it the
charges are not against any individual but against a medical
journal, which is not a member, and the only way the So-
ciety could reach it would be by discontinuing its patron-
age unless it complies with the Society's wishes. I do not
think it is a charge against Dr. Register individually.

The President : The resolutions are adopted.

The Society will be in order. The consideration of the
regular jDrogram will be resumed by the reading of paper
Xo. 33.

Dk. W. S. Kankin: I move, in view of the fact that so
many have gone to dinner, that we adjourn to dinner and
have Dr. Hodges's paper immediately after dinner. Motion
carried.

Convention here took a recess until 3 p. m.

FooT-xoTE BY EDITOR. — The attention of the Editor of the Charlotte
Medical Journal, Dr. E. C. Register, who was absent from the Winston-
Salem meeting when the above proceedings were had, having been called
to the Society's action the July, 1908 issue of the Charlotte Medical
Journal contained the following statement:
A STATEMENT.

On the 1.5th of May, Mr. J. J. Wootton, advertising and subscription
manager of the Charlotte Medical Journal, sent to this office an ad-
vertisement of the Biggs Sanitarium, Greensboro, X. C.

The advertisement was not read by the editor or by any one con-
nected with this Journal who might have recognized its unethical
character, and since those through whose hands it passed knew nothing
of Mr. Biggs's history, the advertisement found its way into our columns
without those who j^assed it having any idea that it was irregular.
Of course Mr. Wootton, a layman, would not know much about medical
ethics, consequently he accepted Mr. Biggs's advertisement without any
investigation.

A few hours before leaving Charlotte for the Winston meeting of
the North Carolina Medical Society, I received two letters from two
Greensboro physicians, calling my attention to Mr. Biggs's objection-
able advertisement. Then I read the advertisement for the first time,
and fully realized that a mistake had been made, and that the ad-
vertisement should not only never have appeared, but should be elimi-
nated as soon as practicable.

On my arrival at Winston I made the above explanation to Drs.
Dodson, Turner and Williams, all of Greensboro. Later I learned that
they with several other Greensboro physicians, proposed to bring the

156 fifty-fifth annual session

Thursday Afternoon.

Society reconvened at 3 :20 p. m.

"The Eesults of Surgery as Seen by the General Prac-
titioner," etc. Read by Dr. J. Allison Hodges, Eichmond,
Virginia.

DISCUSSION.

De. J. F. HiGHSMiTii : I have enjoyed Dr. Hodges's paper
very much, and it has opened up a field that is very exten-
sive. We have good authorities on all sides on this subject.
I will address my remarks in just a few words.

We should always be extremely careful to diagnose these
cases. That is the keynote to the whole situation. We
all know the importance of correct diagnosis in any dis-
ease. In the first place, a physician has to have experience
to know how to diagnose these cases of ovarian disease. Many
cases that come to the surgeon have been sick for years.
They may have contracted some specific trouble five years,
perhaps, before, and it has run on, like a thorn in the flesh,
existing from time to time, and you can not conceive the
suffering which they have undergone, and when you really
learn the trouble you are astonished how they have under-
gone these conditions and lived.

matter before the Society. On the last day of the Convention, when a
majority of those in attendance upon the session were absent, and
after I had left for Charlotte, the matter was brought before the general
meeting, and condemnatory resolutions passed without my explanation
being mentioned or heard.

The Charlotte Medical Journal has alwaj^s stood for high ideals in
medicine; its policies have always tended to build up the medical pro-
fession of the South, and especially of North Carolina. It has made
mam' mistakes; it has fallen short in many instances, but its intent
to do good has certainly always been apparent.

Whenever any physician, anywhere in this Southland, wishes to
criticise the methods of the Journal, if he will do so in a friendly,
brotherly-like manner, he will be listened to, and what he has to say and
whatever suggestion he has to make will be given a most careful con-
sideration.

To the members of the Medical Society of the State of North Carolina.

Edward C. Register, Editor.

N. C. MEDICAL SOCIETY. 157

Oue can not tell the general anatomical conditions that
exist without an exploratory incision. It all depends upon
jour experience and in knowing when to quit, and how far
to go.

It has been my experience that diseased ovaries should
be removed, but the question is, are they diseased, or are
they not diseased ? I have opened the abdominal cavity
many times and found an ovary, and could not tell whether
it was diseased or not. I have been on the fence, and did
not know what to do, whether to be conservative or radical.
But the ovaries that were diseased I removed and referred
to a first-class pathologist.

As I grow older I do not make a mistake often, which
differs from the pathologist. His reports are generally re-
turned to me as a chronic osphoritis. ovarian tissue all gone,
etc.

"Where you have diseased conditions I believe the radical
operation is the best, and the more experience I have the
more I am of this opinion, the less I see in plastic surgery
of the ovary.

W. J. Mayo has no halfway gTound. If an ovary is at
all diseased he removes it or lets it alone. He don't tamper
with it. As to all acute conditions of the ovary, I believe
they should be let alone and conservatively treated from
time to time until the case is cleared up or developed surgi-
cally.

I call to mind a case that I had recently. A patient Avas
brought to me, her doctor thinking she had appendicitis.
She had a pain low down in the right iliac region, extending
up around McBurney's point, with a great deal of rigidity.
I studied the case a few days and wrote the doctor, advising
an exploratory incision. At the operation we found every-
thing was adhesions. We found adhesions on all sides of the
uterus, ovaries and tubes bound down, also many bowel ad-
hesions. I felt that I had gone up against an acute septic
condition. I thought to trv to remove these ovaries and free

158 FIFTY-FIFTH ANNUAL SESSION

adhesions at that time I would lose mj patient. Sometimes
it takes more courage to stop than it does to keep on. I
closed my incision. In a short time the patient was able to
leave the hospital and was advised by friends to consult some
other surgeon in regard to removing her diseased organs,
which she did three months after I saw her. This surgeon
removed the ovaries completely and the patient got abso-
lutely well.

At the time she came into my hands if I had removed
these organs I have no doubt the patient would have died,
but after the acute stage was passed the operation gave relief.

We can not under-estimate the great value of studying
the different organs before we go into the case, especially
the kidneys, the heart and lungs, and the general tone of the
system at large.

I have operated on cases where I would remove one ovary
and leave one, and it would only be a matter of time until
the patient would come back to me suifering, almost wild.
I removed the other ovary, doing a complete hysterectomy,
and the patient would get absolutely well. The truth was
these organs were diseased when she was first operated upon,
but it was hard to tell the extent of the disease. We gave
the patient the benefit of the doubt.

We can not underrate Dr. Hodges's suggestion, when these
patients have been suifering so long, not to send them home
in two weeks from the hospital. I do not let them go home
under three or four weeks. Then I write to their physician
and ask that he keep his eye upon them for some time. This,
many times, is worth as much as the operation. To operate
without it would be a failure. To operate with it is a suc-
cess.

As to vaginal douches, I think that they have their place,
and many times I think they are used when they have no
place. Local applications, glycerine, tampons, etc., we have
to use sometimes, when we can not do better.

N. C. MEDICAL SOCIETY. 159

Dk. Haines: Mr. President and Gentlemen: I just
want to say a word in commendation of Dr. Hodges's paper
and of Dr. Highsmith's discussion.

I think we ought to consider before we operate on these
cases. I believe Dr. Hodges has struck the keynote on the
subject. ,

I think in many of these cases by proper physiological
treatment we can relieve them of this trouble, and I wish this
Society to give a vote of thanks to Dr. Hodges for his valu-
able paper on this subject.

Dr. Knox: Mr. President: I desire to second that
motion. It is a very thoughtful paper, and I think a very
valuable one and worthy of the close consideration of every
surgeon present. My opinion is that a large number of sur-
geons do rush them in and rush them out in too big a hurry
,to get beds for other patients.

Dr. Hodges's paper has been a very suggestive and help-
ful one to me, and will be a source of thoughtfulness and
helpfulness to others, I am sure.

Dk. Joseph Graham, of Durham, K". C. : I listened to
Dr. Hodges's paper with much interest; it is a very able
paper and touched a very important subject.

Surgery has undergone many changes. First we had
heroic surgery, next anatomical surgery, then antiseptic
surgery. "We are now beginning the great age of physiologi-
cal surgery.

I think the most important thing in connection wath the
class of cases Dr. Hodges speaks of is a full and accurate
diagiiosis, a thorough study of the patient ; not only a study
of the actual disease, but a study of the mental and nervous
condition.

Frequently these cases are referred to a surgeon for ope-
ration and little attention is paid the nervous temperament.
This is a great mistake.

I do not know anything that has appealed to me more

160 riFTY-riFTH ANNUAL SESSION

strongly than the words of Dr. William Striidwick, of Hills-
boro. He said that it was just as important to know what
kind of a patient the disease had as to know what kind of a
disease the patient had. This has been worth a great deal
to me in my work.

The question bi what to do and what not to do in operating
on these eases must be decided by the experience of the in-
dividual operator. I think the remarks of Dr. Highsmith
covered that ground.

The important thing is the relationship of the family
physician and the surgeon. To accomplish the best results
the family physician and the surgeon must Avork in company,
shoulder to shoulder.

Dr. Haines: Mr. President: I move that this Society
extend to Dr. Hodges a unanimous vote of thanks for his very
valuable paper.

The President: Gentlemen, that vote has been moved
and seconded. It gives me much pleasure to call for your
unanimous vote. Motion unanimously carried.

Dr. Hodges: Mr. President mid Gentlemen: I wish to
thank you for the courtesy that you do me. If you live in a
city, like I do — among friends, it is true, but not the friends
of my youth, not the friends of my boyhood, nor the friends
of my early manhood — you can appreciate what I feel every
time I come to North Carolina, for I always go back with a
deeper love and a stronger affection and a purer adoration
for the people I was born among than ever before. (Ap-
plause. )

You can appreciate the sentiments that I feel in being
among my own people, and the feeble paper that I have read
here this afternoon has been but a voice crying in the wilder-
ness of medicine, earnestly asking that the physician and the
surgeon v;ork in harmony and in thorough cooperation, for
the best interests of their patients. I believe, moreover, that
medical and surgical science will be advanced thereby, for

K". C. MEDICAL SOCIETY. 161

living ill a city, as I do, and spending niiicli of my life in
other cities, I know that specialism has run mad, and that
somehow or other, the family doctor is about to pass away
and be no inore.

This paper was intended as a protest, gentlemen, against
allowing the famih' physician to be forgotten in this great,
supposed advance of medical and surgical learning, and that
he be asked to operate and cooperate with the specialists; for
all that we work for — not for money, not for plaudit, nor for
praise, — is poor, suffering humanity, and I know you will
join with me in doing all that you can towards that glorious
end. And now I thank you again for your cordial kindness.
(Applause.)

The following papers were then read :

"Vaccine or Tuberculin Therapy in the Treatment of Tu-
berculosis," read by Dr. H. B. Weaver, Asheville, K. C.

"The Treatment of Incipient Tuberculosis," Dr. J. E.
Brooks, Greensboro.

''The Use and Abuse of Drugs in Tuberculosis," Dr. W. M.
Jones, High Point, IST. C.

DISCUSSION OF TUBEKCULOSIS PAPERS.

Dr. G. L. Sikes: Mr. President: I did hope to hear, in
the treatment of tuberculosis, some good instructions in re-
gard to the preventive cure of tuberculosis, and as the
Avestern counties of our State are especially noted as the re-
sort of tuberculous patients, I hope that the men, at our next
meeting, will give us some preventive treatment along the
line of tuberculosis.

Dr. Wm. L. Dunn, Asheville, IT. C. : Mr. President:
I would like to say just a few words in discussion of the
papers that have just been read.

First, I would like to speak particularly concerning the
paper of Dr. Weaver, in which he has emphasized "tubercu-

162 FIFTY-riFTII ANNUAL SESSION

lin-tlierapy," to which he has applied the name, so popular
to-day, "vaccine-therapy."

"Vaccine-therapy" primarily implied control of dosage by
determination of the opsonic index, which has shown itself
to he so impractical in use that it has been practically aban-
doned in the control of the administration of tuberculin. It
has, however, served us one good purpose. The use of the
term "vaccine-therapy" has given opportunity to many of the
bitter opponents of tuberculin to back down gracefully from
their extreme opposition to tuberculin.

It is a remarkable thing to me that I can learn of no man
who has ever given tuberculin for any period of time, and
used it properly, and in a suflS-cient number of cases to form a
proper judgment, who has ever abandoned its use.

I want to raise my voice again, however, in the defense of
the clinical method of administration of tuberculin in contra-
distinction to the administration controlled by the opsonic in-
dex. A method that has been in successful use for so many
years can not be wholly wrong. I have used tuberculin for
about fourteen years, and can not believe my methods have
been altogether wrong. I do not think it is quite right to
speak of the use of old tuberculin as a vaccine. As to any
particular tuberculin, I think the statistics will show that the
results obtained from the various tuberculins are practically
the same. One who has familiarized himself with any one
preparation should be slow to make a change. As to dosage.
I feel sure that there will be some reaction from the extremely
small doses which we are at present using. One of the
greatest dangers of tuberculin-; herapy is the tendency c.-f
those who use it to depend too much upon it and to neglect
the dietetic-hygienic regimen which must always be the cen-
tral point of treatment to which all other things must staml
in the relation of an adjunct or aid, be that tuberculin or
what not.

There is one other point : I wish also to say that Wright's
method did not mark the beginning of an era of the proper

N. C. MEDICAL SOCIETY. 163

use of tuberculin. In mv opinion tuberculin was used prop-
erly many years before Wright advocated tlie control of ad-
ministration by determination of opsonic index. The word
"cure" is used altogether too loosely, in speaking of tubercu-
losis. It is quite impossible for any man to know that a
patient is cured of tuberculosis at the completion of any
form of treatment, I care not what may be the physical signs
of that patient. Time alone can determine this. It is my
custom to never discharge a patient as "cured." I tell him
that if he remains well for two years and does not react to a
tuberculin test at the end of that time that he can reasonably
consider himself as a cure.

I understood Dr. Jones to say that the treatment is not
further advanced than it was a hundred years ago. I think
he will find that position hard to maintain. As to mixed in-
fection, we must not confuse laboratory and clinical mixed
infections. In treatment of hemorrhage, if we use atropine,
it must be used in large doses. I use from 1/30 to 1/20 of
a grain at a dose.

Dk. J. E. Brooks, Greensboro: I do not know whether
Dr. Dunn understood me or not in regard to the word "cure."
I am glad he takes the position that he does. I tried to make
myself clear on this point.

I repeat a sentence in my paper — "All tuberculous patients
when cured, if cured, are cured conditionally." I said, "if
cured," advisedly, because I doubt if any patient who has
tuberculosis should be discharged as cured, without telling
him that the disease is prone to return.

I think that in most instances the cases that return have
not been instructed that the disease is liable to return, and
that no doctor knows when a case is cured.

Dr. Weaver : I have nothing further to say.

"Report of a Case of Typhoid Cholecystitis," Dr. W. A.
Graham.

164 FIFTY-FIFTH ANNUAL SESSION

DISCUSSION.

Dr. Highsmith: Mr. President: It is a pity we have
such little time in which to discuss so many papers.

This paper is very interesting to me.

I would like to emphasize how many times, in typhoid
fever, we have cholecystitis, going on to suppuration, and
the importance of the general practitioner always keeping an
eye open for just such cases as Dr. Graham reports.

I have a similar case — a lady fifty-six years old — who went
through the stages of typhoid. She did not have any hem-
orrhage, hut, according to all the clinical symptoms, it was
typhoid fever. Occasionally she would have a high tempera-
ture, going down to normal, indicating pus. She became very
jaundiced, and I opened and drained the gall bladder and
found it filled with gall-stones — nothing but mucus or pus
passing out — no bile ; drained gall-bladder in the usual way,
by a rubber tube attached to the peritoneum.

She made an uninterrupted recovery and has been well
ever since. It is wonderful how these cases get well, once
you relieve the diseased conditions that exist.

De. Kent, of Lenoir: Mr. President: Just a little mat-
ter. I was appointed chairman of the committee to look
after the printing of the Constitution and By-Laws, and the
copy that was recognized to-day as being the correct copy,
was, by accident, lost among the Councilors. I would like
for the pamphlet to be placed in my hands by whoever has
it. It was in pamphlet form and is easily recognizable.

The President: Thank you, doctor. The gentlemen
hear you and will doubtless act accordingly.

"Influenzal Arthritis," Dr. Philips, of Tarboro.

The President: I offer apologies to the doctor for not
inviting discussion of his paper, but the small numbers and
the growing lateness of the hour make it necessary that I
now request the Secretary to make a report from the House
of Delegates of the oflicers-elect and other items of interest.

N. C. MEDICAL SOCIETY. 165

The Secretary : I wish to call attention to section seven

in the Bj-Laws. It reads as follows: (Section here read.)

We may, later in the year, call your attention to it again.

The Secretary: The JSTominating Committee organized
with all members present. Dr. A. A. Kent, Chairman; Dr.
John Hill Tucker, Secretary. The following is the list of
nominations :

President — Dr. J. F. Highsniitli.

First Vice-President. — Dr. C. M. Poole.

Second Vice-President. — Dr. D. A. Garrison.

Third Vice-President. — Dr. J. A. Dees.

Orator. — Dr. Charles W. Moseley.

Essayist. — Dr. W. L. Dunn.

Leader of Debate. — Dr. L. B. Newell.

Delegates to American Medical Association. — Drs. J. Howell Way,
A. J. Crowell, these two gentlemen each two years; D. A. Stanton, one
year.

Alternates. — Drs. P. J. Thomas, D. S. George, H. H. Dodson.

Finance Committee. — H. S. Lott, R. E. L. Flippin, J. M. Blair.

Obituary Committee. — Drs. Charles A. Julian, A. A. Kent, S. T.
Nicholson.

Committee on Publication. — E. C. Register, W. H. Wakefield, D. A.
Stanton.

Committee on Public Policy and Legislation. — Drs. R. H. Lewis,
George G. Thomas, Albert Anderson and the President and Secretary,
ex officio.

Committee on Scientific Wo7-k. — Drs. John Bynum, W. S. Rankin,
and the Secretary ex officio.

Delegates to the Mississipjn Valley Association. — Drs. W. 0. Spencer,
W. R. Kirk, M. L. Stevens, Cyrus Thompson, W. D. Pemberton, J. H.
Shuford.

Delegates to the Virginia Medical Society. — Drs. J. S. Dalton, Jos. J.
Philips, J. M. Williams, J. S. Gilbert, S. C. Heighway.

Delegates to the South Carolina Medical Society. — Drs. W. D. Wither-
bee, D. M. Dalton, J. F. McKee, R. J. Disosway and Earle Grady.

Next Place of Meeting. — Asheville, N. C.

Time of Meeting. — Third Tuesday in June.

De. Weaver : I move that this report from the House of
Delegates be received by the Society. Motion carried.

The Secretary: Mr. President: I have another little
matter which the House of Delegates unanimously endorsed,
which I will read:

166 FIFTY-FIFTH ANNUAL SESSION

At yesterday's regular session of the House of Delegates,
Dr. J. Howell Way, the President of the Society, vacated
the chair, and on behalf of himself and Dr. Laughinghouse
introduced the following and moved its unanimous ado])tion :

Whereas, The people of the State of North Carolina have by a
large majority vote, ratified an Act which, after January 1st, 1909,
makes illegal the sale of intoxicating liquors in North Carolina, ex-
cept upon physician's prescription; and

Whereas, The Legislature of North Carolina, in framing the Pro-
hibition Law, did evidence great confidence in the medical profession
of said State, by jjlacing in the hands of said profession to an extent,
the success or failure of the law, in that the members of the said medi-
cal profession are given the right to prescribe spirituous liquors at
their discretion: Therefore be it

Resolved. Fvrst, That the Medical Society of the State of North
Carolina in fifty-fifth regular annual session assembled, do hereby con-
demn as unprofessional and grossly immoral any lax or unfaithful
conduct in its members in the exercise of the privileges conferred in
this law.

Second, That the Medical Society of the State of North Carolina
respectfully urges upon all the physicians of this State, whether
members of this Society or not, to join us in demonstrating to the
people that the members of the medical profession can be relied upon
implicitly, to perform their full duty in aiding in the enforcement of
the Prohibition Law, and in building up a public sentiment that will
insure protection against an illegal traffic in intoxicating liquors.

Third, That the Medical Society of the State of North Carolina re-
spectfully urges upon the State Board of Medical Examiners of North
Carolina the manifest duty of revoking the license to practice of any
physician who may be proven guilty of abusing the privilege accorded
him in the prescribing of intoxicants.

J. Howell Way, M.D.

Chas. J. 0"H. Laughinghouse, M.D.

The President, Dr. Way: These resolutions were
adopted at my instance, unanimously, and without suggestion
or dissent, by your House of Delegates, and are brought before
you with the hope that you will, by unanimous endorsement,
place the Society upon an unqualified record in dealing with
this responsible question under the law.

Dr. Whittington : I move, sir, that these resolutions
be adopted and be allowed to take their proper course.

N. C. MEDICAL SOCIETY. 167

De. Sixes : In view of the resolutions that "we have just
heard read, and in view of the fact that our Christian advo-
cates, the religious papers, the organs of our churches, are
daily carrying in their columns the same advertisements that
are poison to our country, and that the clergy are, by their
use and patronage of quack narcotics, making dope fiends
daily, we ask them to desist from carrying something in their
papers which is poison to the people of our country, inasmuch
as the physicians regard this as detrimental to the Christian
work of our country.

I think, sir, the medical profession of our country ought
to ask the ministers to take steps to remove poisonous adver-
tisements from the columns of the papers that claim to be
our Christian advocates.

The President: Dr. Sihes: The Chair appreciates
fully the truth of what you have said, and there is probably
not a j^hysician of ten or more years experience present who
does not recall more than a single instance in his own prac-
tice of ministers habitually using and recommending to their
parishioners various and sundry mixtures that we know to
be poisonous and hurtful ''dopes" ; but I gently call to your
attention the fact that the House of Delegates in passing
unanimously these resolutions was merely intending at this
time to endeavor to "clean its own house," leaving the clerical
offenders to their own consciences. I therefore ask that you
do not insist on amending the resolutions. Is there further
discussion of Dr. Whittington's motion ? If not, those favor-
ing it let it be known by saying "Aye." Those opposed, "Xo."
Motion carried unanimously.

The Peesidext : Gentlemen of the Medical Society: It
is apparent — at least it appears to be apparent — you know
as presiding officer I am somewhat uncertain about things
(laughter) — it appears to be apparent that we are very near
the time for adjournment, and I am going to ask Dr. A. W.
Knox and Dr. H. B. Weaver, two of the honored past Presi-
dents of this Society, to present at the President's desk the

168 FIFTY-FIFTH AiXNUAL SESSIOIS^

President-elect of this honored body. But before I do so I
will trespass upon your time for about one minute to again
extend to each and every one of you my sincere and hearty
thanks and appreciation of the numerous honors that I have
enjoyed at your hands, and also to thank you again and again
for the uniform courtesy which you have shown me as your
presiding officer during this session.

I thank you, gentlemen, and I retire from this chair feeling
that I have enjoyed in occupying it the greatest distinction
that ever came to me in my life, and I expect to receive none
in future years that I esteem and shall prize more highly
than the honor of having been your presiding officer.

Again, gentlemen, I want to say that as your presiding
officer I may have made mistakes. My judgment and my
rulings at times and my way of enforcing them may have
seemed a little harsh or a little rasping, or perhaps grated at
times upon the sensibilities of some of the gentlemen pres-
ent; but I want to say, gentlemen, that if an error was made
it was an error of the head and not of the heart.

I feel, gentlemen, that every one of you are my friends,
and I retire from this chair and from this meeting with a
heart full of affection and kindly feeling for every gentleman
present.

I will now ask Drs. Knox and Weaver to escort the Presi-
dent-elect to the chair.

De. Knox: Mr. President: Before complying with
your request you will pardon me if in behalf of this Society,
as well as expressing my own sentiments, I desire to say a
few simple and kindly w^ords to yourself.

During the days of this meeting, and particularly during
the exciting session this morning, deep feeling ran high, and
there Avas gTcat tension everywhere. You, sir, with admir-
able poise and great self-possession guided the great ship of
this Society safely and wisely around some threatening sub-
merged rocks, into safe, smooth waters, and the lowering
clouds of a threatening storm subsided.

I think I may say that this Society and its members ap-

K. C. MEDICAL SOCIETY. 169

predate most keenly your deliberate and thoughtful action,
and emulating your example will go home with a determina-
tion to meet this thing that has arisen in a deliberate and
dispassionate way, with good feeling among ourselves and to-
ward yourself. We have sought in every way to get at the
right management of that matter that came up this morning,
and we will get at it in the right way, and we wish to say
to you in parting — voicing I believe the sentiments of those
present — the Society has for you, as I have, the highest es-
teem and the most kindly feeling. (Applause.)

The Society applauded as the President-elect, Dr. J. F.
Highsmith, was led to the chair.

Dr. Weaver presented Dr. Highsmith to the President.

The Pkesibext, Dr. Way: Gentlemen of the Society:
It affords me great pleasure to introduce to you as my suc-
cessor in this chair Dr. Highsmith, of Fayetteville, as your
honored President, and in doing so I make no perfunctory
statement that the Society has not only honored Dr. High-
smith by making him President of this honored body, but has
likewise honored itself, for I feel that during the vear to
come and at the occasion of your next annual meeting it will
be the proud privilege of Dr. Highsmith to discharge its im-
portant duties with fidelity, with honor and credit to himself
as Avell as to this honorable body.

(Dr. Way then handed the gavel to Dr. Highsmith and
retired to a seat in the body of the Society, and Dr. High-
smith assumed the duties of President, prefacing his taking
the chair with the following remarks) :

De. Highsmith: Fellow-meinhers and Brethren of the
North Carolina Medical Society: I have no words to ex-
press my feelings at this moment. This honor, which has
come to me unsought, was like a clap of thunder from a clear
sky. Little did I think that I would be made President of
the ISTorth Carolina State Medical Society at this meeting.
I had thought that I must work in the harness for some years
to come before I could ever aspire to such a place.

170 FIFTY-FIFTH ANNUAL SESSION

And now I want to ask each member of the Society of the
State of !N^orth Carolina and each physician of the State, who
does not belong to the Medical Society, to join our body and
let ns mutually work together, hand in hand, and try by hon-
est effort to equal the noble work that has been done by our
co-laborers in the past, and if possible to make the coming
year one of great success ; one that shall be looked upon for
coming ages as the turning point that made us a unit, brought
us nearer together and dismissed from us all selfish desires,
brouffht us in close contact and made us lav aside all selfish
motives and seek science in its truest and best sense, that
suffering humanity may receive all that is due it.

I shall attempt to do my full duty, and I hope that the
members of the medical profession of our dear old State of
Xorth Carolina will uphold my hands, and will ahvays feel
free to come to me as the head of the profession for the com-
ing year, to advise me, and that we conjointly may rule our
State as it should be and as it has been in the past. I thank
you again;

Dr. Weaver: 21 r. Chairman: As I presume all of the
papers have not been read I move that the remaining papers
be referred to the Committee on Publication,

Seconded by Dr. McBrayer.

President Highsmith appoints the following chairmen of
sections for ensuing session:

Anatomy and Surgery. — Dr. T. E. W. Brown, Asheville, N. C.

P'-actiee of Medicine. — Dr. Edward J. Wood, Wilmington, X. C.

Materia Medica and Therapeutics. — Dr. John Q. Myers, North Wilkes-
boro, N. C.

Gynecology. — Dr. Hubert A. Eoyster, Ealeigh, N. C.

Obstetrics. — Dr. A. B. Croom, Maxton, X. C.

P(cdiatrics. — Dr. James J. Philips, Tarboro, N. C.

Physiology and Chemistry. — Dr. L. B. Newell, Charlotte, N. C.

Railway Surgery. — Dr. J. Vance McGougan, Fayetteville, N. C.

Pathology and Microscopy. — Dr. Watson S. Eankin, Wake Forest,
N. C.

Medical Jurisprudence and State Medicine. — Dr. W. P. Holt, Duke,
N. C.

]Sr. C. MEDICAL SOCIETY. 171

De. Jewett : 2Ir. President: Is it in order to make a
motion just now ? Is it in order to present a motion ?

The President : I would saj so, sir.

Dr. Jewett: I would like to move tliat the President
appoint a committee of three to investigate the cost of a pub-
lication of a monthly journal and consider the advisability
of the Society establishing a journal to take the place of the
published volume of Transactions.

In offering this motion, in the face of the contrary expres-
sion of opinion of our President in his address, I would say
that several months ago I investigated the standing of the
journals of those societies that have adopted State journals,
and I wrote to each one of them and have in my hand replies
from each and every one. They are all enthusiastic about
it and claim that under no consideration would they return
to the old form of the annual Transactions.

I ask that a committee be appointed to investigate this
thing and report to our House of Delegates at our next an-
nual meeting.

Dr. Weaver: J/r. President: I feel that that is a very
important matter — an untried experiment in this State. I
think it would require a very sagacious committee to attend
to it. There are too few here now to consider so important
a question as that.

Dr. Whittington : 2[r. President: I second the motion
for the appointment of a committee.

The President: It has been moved and seconded that
the President appoint a committee of three to investigate the
cost of a monthly journal and consider the advisability of the
Society establishing such a journal to take the place of the
volume of Annual Transactions, said journal to be published
under the guidance of the House of Delegates, and that the
committee be requested to report at our next annual meeting.

Dr. Knox : I desire to offer an amendment to that mo-
tion : That the President, if that motion is carried, appoint

172 riFTY-FIFTH ANNUAL SESSION

this committee at his leisure, after an adjournment is taken,
so that he will have ample time to consider its personnel.

Dr. McBrayer: That is a very important matter, sir,
I move that that be referred to the Committee on Publica-
tion. It seems to me that that would be an appropriate com-
mittee. I move, then, to amend the motion of the appoint-
ment of the committee by referring it to the Committee on
Publication.

Seconded by Dr. Laughinghouse.

Dr. Jewett: Mr. President: I do not see how it is ex-
actly proper for such an amendment to this action, for the
simple reason that at least one of the Committee on Publica-
tion has already expressed himself as decidedly opposed to
any such action. Dr. Eegister, as editor of the Charlotte
Journal, wrote an editorial some months ago in which he op-
posed any such action, and did not uphold State Society jour-
nals in general.

The idea was to have an independent committee, one thor-
oughly neutral, to investigate the matter and find out for
themselves whether or not it would help this Society. And
that is all that the committee is for — simply to investigate it
and find out whether it is a desirable thing to do, and report
it to the House of Delegates for their decision and action.

Dr. Whittington : I feel that this amendment oudit to
be voted down from the fact that it will not enable us to get
at the very thing we wish to get at. I am sure the maker of
this motion — nor do I intend any thrust at the Charlotte
Medical Journal, at the Publication Committee, or at the
manner of getting out the Transactions of this Society — and
this is merely for the consideration of this body; and that
is more impartially gotten at by referring it to a committee,
and not to the Publication Committee, since one of the com-
mittee is editor of the Charlotte Medical Journal.

I thought that tlie Charlotte Medical Journal had been
adopted as the organ of the ISTorth Carolina Medical Society.

N. C. MEDICAL SOc'iETT. 173

Then my remarks are in opposition to the amendment, and
I contend for the original motion.

The Presidext, Dr. Highsmith : I fully realize the im-
portance of the situation and shall not appoint any committee
now, and shall give it further consideration, and I feel that I
should appoint a committee who will look after the thing with
the same care as the Committee on Publication would.

Dr. Way : I move that we now adjourn sine die.

Dk. Weaver: I second that motion, that we now adjourn
sine die.

(Cries of "No," "Is^." "Vote that do^vn.")

Dr. Knox: I ask that the President put that motion to
the house.

Dr. "Way : Mr. President : I renew my motion that this
body do now adjourn sine die. And since you have delayed
the putting of an undebatable motion, by courtesy, I wish to
say I understood when I came to this meeting three days ago
that a move would be made during the meeting for the es-
tablishment of a Society journal. I have listened in the
House of Delegates, which is the duly appointed place to con-
sider all such business propositions, and not here, for some
movement there looking towards a journal establishment,
and no move was made. !Kearly four hundred members have
been here this week.

As a member of this Society I emphatically protest against
the introduction of such an important matter on the eve of
closing, with only a handful of men in the house — ^not ten
per cent of the registered attendance — and within a very few
minutes of the train that several of us expect to go upon.
That is my reason, and again I move that we adjourn sine die.

Dr. Whittington : Dr. Way has been allowed to de-
bate that question, and I want to say it is evident that some
(\i the members of this Society do not want this question con-
sidered, and I have my own opinion as to their reason, and I

174 FIFTY-riFTH ANNUAL SESSION

therefore beg that we vote down this motion to adjourn and
that we shall be allowed to vote upon this thing.

There are now more members in this house by twice than
the members that constitute the House of Delegates, and it is
to their interest that we be allowed to vote upon this thing. I
appeal to the members to vote down this motion of Dr. Way's
and that we be allowed to vote on this committee.

Dk. Way : In renewing that motion to adjourn I said
''by courtesy," and nobody objected. Waiting a moment I
made an explanation as to why that motion was made. I re-
new the motion that the meeting adjourn sine die and de-
mand, Mr. President, a vote.

The Peesident : All in favor of adjourning let it be
known by rising. (Fifteen arose.)

All opposed to adjourning please rise. (Thirteen arose.)

The President: Gentleme^i: I declare the house ad-
journed sine die.

J. Howell Way, M.D.,
D. A. Stanton, M.D., President.

Secretary.

North Carolina State Medical Association

FIFTY-FIFTH ANNUAL SESSION
Winston-Salem, North Carolina, June 16, 1908

FIFTH ANNUAL SESSION OF THE HOUSE OF DELEGATES

The House being called to order by the President, the roll
being called, the meeting proceeded to call the Council for
the different districts as follows :

First District — Dr. Oscar McMullin. Absent.
Second District — Dr. R. A. Whitaker. Absent.
Third District— Dr. F. H. Russell. Present.
Fourth District — Dr. Albert Anderson. Present.
Fifth District— Dr. J. F. Highsmith. Present.
Sixth District — Dr. H. A. Royster. Absent.
Seventh District — Dr. C. M. Strong. Present.
Eighth District — Dr. J. B. Smith. Present.
Ninth District — Dr. Isaac M. Taylor. Present.
Tenth District — Dr. J. A. Burroughs. Present.

Upon the roll-call of delegates representing the different
counties the following reported :

Currituck — None. >

Pasquotank-Camden-Dare — Dr. H. D, Walker.

Perquimans — R. M. Smith.

Hyde— Dr. J. A. Mann.

Hertford — None.

Martin — Dr. J. H. Saunders.

Pitt— None.

Bertie — Xone.

Beaufort— Dr. S. T. Nicholson.

Lenoir — Dr. J. M. Parrott.

Jones — No report.

Craven — Dr. N. M. Gibbs.

Pamlico — Dr. D. A. Dees.

Carteret — Dr. D. S. George.

New Hanover — Dr. E. J. Wood.

Pender — None.

Onslow — Dr. J. L. Nicholson.

Duplin — Dr. J. L. Lane.

Bladen — None.

176 FIFTY-FIFTH ANNUAL SESSION

Sampson — Dr. G. L. Sikes.

Columbus — Dr. L. Brackett.

Brunswick — None.

Xorthampton — Dr. H. W. Lewis.

Halifax — Xone.

Nash — None.

Edgecombe — Dr. J. J. Philips.

Johnston — Dr. J. B. Person.

Wilson— Dr. E. T. Dickinson.

Wayne — J. D. Roberts.

Greene — Dr. W. B. Murphy.

Cumberland — Dr. K. G. Averitt.

Robeson — Dr. A. B. Croom.

Scotland — None.

Richmond — None.

Montgomery — Dr. J. B. Shamberger.

Moore — Dr. R. W. Palmer. ^

Harnett— Dr. W. T. Holt.

Chatham — Dr. W, M. Burns.

Wake — Drs. Chas. V. Wilkeryon and R. H. Lewis.

Franklin — None.

Warren — None.

Vance — Dr. John H. Tucker.

Granville— Dr. S. D. Booth.

Person — None.

Caswell— Dr. M. H. McBride.

Alamance — Dr. George W. Long.

Durham — Dr. T. A. Mann.

Anson — None.

Union — Dr. J. M. Blair.

Stanly— Dr. T. A. Hathcock.

Mecklenburg — Drs. J. P. Munroe and E. C. Register.

Cabarrus — Dr. W. D. Pemberton.

Lincoln — Dr. C. D. Thompson.

Gaston — Dr. D. A. Garrison.

Cleveland— Dr. R. C. Ellis.

Rutherford— Dr. T. B. Lovelace,

Rockingham — None.

Guilford — Drs. J. T. Burrus, J. P. Turner and Edmund Harrison.

Randolph — Dr. S. A, Henley.

Forsyth — Dr. J. L. Haines.

Stokes— Dr. L. H. Hill.

Surry— Dr. S. T. Flippin.

Yadkin— Dr. T. W. Shore.

Wilkes— Dr. J. Q. Myers.

Ashe — None.

Davidson — Dr. J. E. Buchanan.

N. C. MEDICAL SOCIETY. 177

Davie — Dr. Thos. D. Watkins.

Rowan — Dr. R. V. Brawley.

Iredell-Alexander — Dr. J. E. McLaughlin.

Catawba — Dr. H. C. Menzies.

Caldwell— Dr. A. A. Kent.

Watauga —

Mitchell — None.

Burke — Dr. Isaac M. Taylor, alternate.

Buncombe — Drs. C. V. Reynolds, T. E. W. Brown.

Yancey — Dr. C. P. Edwards.

McDowell — Dr. B. L. Ashworth.

Madison — Dr. J. C. Tilson.

Henderson-Polk — None.

Haywood — Dr. J. R. McCracken.

Transylvania — None.

Jackson — None.

Swain — None.

Macon — None.

Clay — None.

Graham — None.

Cherokee — None.

Vance— Dr. J. H. Tucker.

AUeghanv — Dr. J. L. Dowdy.

Washington-Tyrrell— Dr. W. H. Ward.

The President put the motion that the delegates answering
the roll-call he declared as representatives.

Motion seconded and unanimously adopted.

Dr. Jas. A. Burroughs put the motion that a committee of
three be appointed to consider and preserve the President's
message.

Motion seconded. Motion adopted.

Pollowing committee appointed: Drs. E. C. Register, E.
J. Wood, J. A. Burroughs.

Reports of committees called for.

Dr. E. C. Register, for the committee, reported the follow-
ing, which was unanimously adopted:

REPORT OF COMMITTEE ON PRESIDENT'S ADDREsS.

Your Committee appointed to consider the President's address and
report on same beg leave to offer the following suggestions:

First. That a vote of thanks should be and is hereby tendered our
distinguished and learned President for his masterly presentation of
a subject of such great and genuine interest to every member of the

178 FirTY-FIFTH ANNUAL SESSION

State Medical Society, for the pleasing style and delightful sketches
in which it abounds, and for the logical order of arrangement which
shows so clearly the to and fro movements of sentiment and idea,
which at various times have characterized the dominating thought of
the profession.

Second. That no one has shown himself so well qualified to address
the society on this subject as has our honored President. At all
times himself a most ardent and zealous disciple of the healing art,
he has unfailingly shown himself ready to acknowledge the worth of
others, and enthusiastic in the bestowal of praise and honor where it
is due. An untiring and unselfish worker in the upbuilding of the
society and the advancement of the science of medicine, he finds in-
spiration in the worthy deeds and lives of those who, in the past,
have toiled in the heat of the noontide, and his tributes to those whose
names are written indelibly upon the records of our progress, could
find birth only in the heart of a man whose devotion is as pure as his
zeal is boundless.

Third. That in presenting this address the President has performed
a service of inestimable value to the whole society, but especially to
those younger men who are just entering upon their participation in
the affairs of a society in the history of which there is a heritage of
noble names and noble devotion, unsurpassed in the annals of any
medical society. A review of this kind your Committee believes to
be timely in that we have become too negligent in honoring the heroes
of our profession.

Fourth. We recommend its publication and commend its careful pe-
rusal by our membership.

Finally, we heartily endorse the expressions therein contained rela-
tive to the glorious prospects which confront the profession of to-day
and concur in those optimistic utterances which would lead us onward
and upward, higher, higher.

E. C. Eegister,

E. J. Wood,

James A. Burroughs,

Committee.

Approved.

The Secretary's report was called for and submitted as
follows :

REPORT OF THE SECRETARY, DR. D. A. STANTON.

Winston-Salem, N. C, June 16, 1908.
Mr. President and Gentlemen of the House of Delegates:

I beg to submit herewith my second annual report. The work of
your Secretary for the year just closing has been much heavier than
last year, not that there was so much more work to do this, than last,
year, but by reason of experience I had a clearer conception of the
work and that of itself multiplied duties.

N. C. MEDICAL SOCIETY. 179

I have the same charge to prefer against some of the county secre-
taries that I had last year, viz, indifference regarding their annual
report of membership of their county society. If this defect could be
overcome the work of the Secretary would be more satisfactory, and
the welfare of the State Society enhanced.

At the time of this report, eightj'-two counties have filed their
reports (eleven more than had reported at the 1907 meeting), giving
a total membership of the State Society to date eleven hundred and
forty-six, a few more than half the physicians in the State.

The gains in new and reinstated members is one hundred and
twenty-seven, and by the time the proceedings of this meeting go
to the press, enough delinquent counties will have reported to make
a membership of twelve or thirteen hundred.

The State Society is in a healthy condition, by far more interest
has been manifested in this meeting than was evidenced in the meet-
ing of 1907.

One of the forcible effects of the good of organization is seen in the
victory won in the matter of life insurance examinations. Three
years ago the profession of this State was in a state of chaos because
of the effort of the life insurance companies to have their examinations
made for $3.00, and because of a disposition on the part of some of
our members to acquiesce to their demands. The better element of
the profession took a firm stand against such an injustice to the
intelligence of the profession, and during the past year we have had
the satisfaction of being informed by every company worthy the name
of a life insurance company that they would pay the old fee of $5.00
in the future. I doubt not that nine-tenths of the old examiners who
resigned have been reinstated to their old places as examiners. This
is one evidence of the good there is in organization.

Since my connection with the profession of the State in an ofScial
way, I have learned a great deal about physicians that I did not
know before; have learned to both love and pity; love those who
have a just appreciation of their high calling, and pity those who are
content to rest on their attainments acquired at college.

The medical profession is too broad and too progressive for any
one to stand still who takes upon himself the responsible duty of
administering to the sick and advising the well how to keep well,
yet quite a large per cent of the physicians of to-day are content to
rest on what they knew the day they received their license, while
others saw that the knowledge which entitled them to a license was
only a foundation upon which to build a superstructure which would
reflect credit upon the profession. This latter class not only have their
own burdens to bear but have also to bear a good portion of the dead
load of the former class.

There is one thing evident to all thinking physicians, if we expect
to measure up to a full realization of our position, and place the
medical profession where it rightly belongs relative to the public —

ISO FIFTY-FIFTH ANNUAL SESSION

and after all it is the public we serve — there are a few reforms which
will have to be brought about. I have never been in favor of going
into politics, but it does seem that we shall have to make ourselves
felt along that line if we ever get what is so badly needed to elevate
the profession to that point where we will be considered other than
neighborhood conveniences. If the medical profession of North Caro-
lina would exert its jjower and influence on the Legislature as the
professional politician does, it would take but two years to work
a reform that in a decade would so change the status of the profes-
sion that the benefits to the public would be so manifest that when
we asked for future legislation a deaf ear would not be turned to us.

This is not the place, and time forbids going into a discussion of
the many factors patent to all, but the temptation is so great to refer
to them and the necessity so urgent for legislation that will result
in good to this commonwealth through the medical profession that I
can not resist referring to them.

The medical profession has already done wonders, but the domain
of our usefulness has scarcely been invaded. The profession has always
been handicapped because we were not felt as a factor in politics.
Because we are physicians and modest in all we do, never going before
the public in that braggadocio manner which characterizes some other
citizens, is no reason we should be overlooked by those in authority
to give us what we need to do still greater things.

It has ever been the opprobrium of the medical profession that its
members are prone to jealousies and uncharitableness towards each
other, and many are the unseemly stories and jokes that this con-
dition of affairs has given birth to and fostered. Much stress is laid
upon the statement that in other professions, as the law and the min-
istry, this does not obtain; and this assertion is accepted as true by
the public without pausing to consider that the frailties of human
nature enter into the business affairs and ambitions of those profes-
sions as it does into ours; and that the contest and rivalries for place,
preferment or money are just as keen, and, in event of failure, are
just as disappointing as they would be in the case of any physician.

That the medical profession has been compelled to bear the chief
odium in this respect is not strange, when we consider how largely
it outnumbers the various other professions, and how intimate is its
relationship with the community at large. A large per cent of eaeli
comnumity does not attend the churches, and a large per centage does
not have recourse to law ; but practically every one has, at some time
or other, need of a physician. It is thus that the unkind word of
criticism has a much larger audience than obtains with any other
calling, and in the course of time has given rise to the fiction that
only in .the medical profession does uncharitableness prevail.

Unhappily, many physicians" are unkind to their brethren, and per-
haps there will always be some who are, but it is the concensus of

N. C. MEDICAL SOCIETY. 181

opinion of the profession of the entire country that in i-ecent years
a marked improvement has been observed in this respect.

Many forces are at work bringing about this changed relationship,
but none has been so potent as the various medical societies, and par-
ticularly the County Medical Society, which brings together the doc-
tors from various localities, and permits acquaintanceship between
those who otherwise would never meet or know each other. It is
surprising how the preconceived opinions that are formed, frequently
unkind or antagonistic, disappear upon closer observation; traits that
were unknown are discovered, unsuspected mental capabilities are re-
vealed, a lovable character is unfolded, and the previously unknown
now commands the respect end esteem that must be given to one who
is recognized as honest, brave and true. It is a matter of great regret
that in every county there are some who do not realize the loss they
sustain by reason of nonmembership and nonattendance upon the
County Society — a loss that can not be expressed in terms of com-
mercial exchange — but loss in the good will and good fellowship that
is there given and received; and loss of the privilege to instruct others.

But there is a commercial side to the question of membership. Vari-
ous positions of profit that only a physician can occupy are withheld
from the nonmember of the Medical Society. The impression prevails,
and correctly so, that the members of the county and State societies
exert a greater influence in their community, are better informed upon
the medical questions of the day, and are the more safe and reliable
counselors, no matter in what capacity their assistance may be soughl.
It is impossible for a physician to frequently mingle with his associates
in the profession without receiving benefit in all the essentials that
are considered requisite for the successful practice of his calling; and
in depriving himself of the privileges and opportunities that are thus
placed at his disposal, is doing himself a greater injury and injustice
than will ever be visited upon him by a colleague.

If the profession is to be more fully organized, if the State society
is to grow in strength of numbers and etficient workers, if it is to be
a factor in securing good legislation for the jjeople, these results must
come chiefly through the efl"orts of the county secretaries. While a num-
ber of the county secretaries have done good work, too many have
failed to even answer my inquiries.

In closing I have one direct request to make of the House of Delegates,
viz, that the County Secretaries be asked to organize themselves into
a working body called the Association of County Secretaries, and that
they be asked to meet some time during the session of the State meet-
ing in 1909, that they may discuss the best ways and means to a more
complete gathering into the State Society, the many who are now
without the fold of the State Society.

Two other requests: First that the House of Delegates fix a date
for holding the annual meeting as provided by the Constitution. The

182 riFTY-FIFTH ANXUAL SESSION

past two years it has been necessary to change the date. This gives
additional work and some exjjense and causes some confusion.

Second: That great care be exercised in the election of delegates to
the A. M. A. At the past two sessions of the House of Delegates, dele-
gates were elected who were not eligible and the mistake was not dis-
covered till near the time of meeting of the A. M. A. This oversight
caused trouble and disappointment to the illegally elected delegates.
Fraternally submitted, D. A. Stantox,

Dr. Booth moves that the report be adopted by the House
with thanks to the Secretary for such a full and interesting
report.

Motion seconded and unanimously adopted without dis-
cussion.

REPORT OF TREASURER.

We, the Committee appointed by the President to audit the Treas-
urer's books, beg to submit the following report:

Balance on hand, June 13, 1907 $1,912.30

Dues collected 2,123.50

Interest 12.38

Total $4,048.18

Disbursements 1, {5.56. 10

Balance on hand, July 1, 1908 $2,392.02

Wm. ]Moxc'Ure,
K. P. Battle, Jr.,
C. 0. Abernethy,
July 1st, 1908. Committee.

REPORTS OF COUNCIL.

First District — Oscar McMullin. No report.
Second District — R. A. Whitaker. No report.
Third District — F. H. Russell. No report.
Fourth District — Albert Anderson. No report.

(Dr. Anderson having moved out of the district it was sug-
gested that a Councilor be appointed in his place if a va-
cancy existed. The Chair ruled that the removal from a dis-
trict of a Councilor forfeits his official position, and declares
a vacancy in that district.)

Fifth District — J. F. Highsmith. No report.
Sixth District — H. A. Royster. No report.
Seventh District — C. M. Strong. No report.

X. C. MEDICAL SOCIETY. 183

Eighth District — J. B. Smith. Xo report.
Ninth District — Isaac Taylor. Xo report.
Tenth District — J. A. Burroughs.

The Tenth District is in a fairly healthy condition and getting on
very well. Yancey County has been reorganized. In Cherokee and
Graham, the territory was so large that with the advice of Dr. Way
and myself, they have organized separate societies. They are now
going to work in Polk County. A greater measure of harmony exists
in the profession than before the organization.

Me. Pkesidext : Does the House desire to take any offi-
cial cognizance of the Council's report more than to enter it
upon record ?

De. J. M. Paekott : I make a point that the State Med-
ical Society depends largely upon the efforts of the Councilors
in their respective districts. Without any reflection what-
ever upon the work of the Councilors, I say that 90 per cent
of the State has not been looked after by the Councilors as
the Society provides that it should be looked after. If the
Councilors are not beneficial to the Society it is the duty of
the Society to do one of three things:

First (and that is the course I advocate), to urge the Coun-
cilors to attend to their business or resign and put somebody
else in.

Second, to make some provision by which the expenses of
the Councilors, when officially engaged, may be paid by the
State Medical Society.

Third, to let the matter stand as it is.

I am opposed to letting it stand as it is. I claim that they
have not done their duty, and I want to urge the Councilors
to perfonn their duty in accordance with the Constitution.
I am not cognizant of one single official action in my district
by the Councilor. If he proposes to get out and do his duty
then continue his services; if not, let him "Shoot Luke, or
give up the gun I" I gave up the position when I held it on
account of the expenses of it. I thought when a State Medi-
cal Society has a balance of $1,000 to $2,000 in its treasury
it was its place to go down in its pocket and pay my hotel fare
and general expenses.

184 FIFTY-FIFTH ANNUAL SESSION

Our Councilor is a first-class gentleman and one of my
best friends. All I blame him for is for accepting the posi-
tion and not doing anything.

I request that the Councilors be urged to become more
active in their duties and that their traveling expenses be dis-
bursed by the State Medical Association.

Motion seconded.

Dr. S. D. Booth : I am sorry that the member of whom
he speaks is not present. The Councilors have assumed a
great deal of duty. They should attend to it, and to pay
their expenses when in official work is no more than neces-
sary.

We have had a district meeting every year and it has been
a very good meeting. These district meetings have done a
great deal of good, and I think it is right to pay the expenses
of the Councilors. I think that would be an inducement to
them to go out and do the work.

Dr. Rodman : We have a clause that provides for tlie
payment of expense.

Dr. Monroe: That is all provided for and I think that
explains to a great extent why these people have not done their
duty.

Dr. Lewis : I find that the expenses of Councilors may
be paid by special action of the House of Delegates.

Dr. Parrott: I presented my bill to the Treasurer, but
he seemed to think there was no machinery sufficient to get
money out of the treasury. I move that the Councilors be
urged to renewed activity and that their traveling expenses
be paid by the Society.

Motion seconded and carried.

. Dr. Lewis : I move that we present the bill of Dr. Par-
rott to the House of Delegates.

Dr. Parrott : That places me in rather an embarrassing
position. I care nothing about it at this time.

X. C. MEDICAL SOCIETY. 185

Dk. Moxkoe: I move that all necessary traveling ex-
penses of all Conneilors .may be presented for payment.

Dr. Stajsttoist: When I look back over the years since
the Councilors were elected to the various districts I must
take position against that amendment. The Councilors have
gone to a great deal of expense, they did it cheerfully. I was
one of them myself in my district. I went over my district
and with other councilors went to Ealeigh to confer with mem-
bers of the Legislature on the call of the then Secretary, Dr.
Way, and not one of us made any charge for time or ex-
penses, and I wish to say the work done then was more ex-
haustive and laborious than any year since as that was the
year we effected our splendid organization of County So-
cieties. I did not keep a memorandum of my expenses and I
could not now recall them. I have no objection to Dr. Par-
rott having his expenses, but I would not be willing to go
back three or four years and get up every expense. Besides,
I do not want it. There are some services neither organiza-
tions or men may pay for.

De. Paekott : I appreciate that motion. I certainly
don't want any back pay for what I did at that time. I would
be delighted if the motion of Dr. Monroe be withdraAvn.

Motion withdrawn.

Communications of general meetings of the Society called
for.
J^one.
KOLL-CALL OF COUNTY SOCIETIES FOR SPECIAL REPORTS.

Alamance — Dr. Loxg: Xothing special to report, but the Society is
getting very lax and does not do niiich work. We have a good deal
of material that we do not appreciate. We have passed through a
great many troubles because we could not assimilate the material
we took in. We are not disorganized, neither have we made any great
progress. We are very inactive and indifferent.

Anson — No report.

Beaufort — No report.

Bertie — Xo report.

Bladen — Xo report.

186 FIFTY-FIFTH ANNUAL SESSION

Brunswick — No report.

Buncombe — No report.

Cabarrus — W. D. Pemberton: We have our meetings monthly. It
is very seldom that the members meet. We have never yet been able
to have a quorum. We have no clinics, but read and discuss papers,
and I think the Society is doing a great deal of good promoting good
will and fellowship among members of the profession.

Caldwell — ^A. A. Kent: Some of the members have not been attending
regularly recently and have lost their membership in that way. We
have our regular meetings every other month. We have very good
papers and discussions and fairly interesting clinics.

Carteret — No report.

Caswell — Dr. M. H. McBride: We only meet twice a year, some of us
live so close to the line and it is so far to go. We have a small
quorum, and we are trying to hold together. We have good meetings
twice a year.

Chatham — Dr. Burns: We have had several meetings, but no good
attendance.

Cherokee — No report.

Cleveland — No report.

Columbus — No report.

Craven — Dr. N. M. Gibes : The Society is in very good condition. We
do not have the membership of the whole county. Some of the physi-
cians live a good distance from the place of meeting. Those who live
close attend. We are standing pat on the $5.00 insurance fee. One of
the members has fallen out, but he has promised to do better and we
have reinstated him.

Cumberland — Dr. Averitt: I am glad to report that we have a very
thrifty County Organization. All of the phj'sicians except two are
members. We have meetings once every month. The profession is
moving on harmoniously. Everybody seems to be in good fellowship.
We have all the members of the profession in our Society except two
men.

Currituck — No report.

Davidson — Dr. J. E. Buchanan: We have a membership of 17
members. Every physician b^ the county is a member of the Society.
Every physician is ready to take each other by the hand, and call him
brother. We have quarterly meetings and some very interesting papers.

Davie — No report.

Duplin — Dr. Lane: Our Association is very active.

Edgecombe — Dr. Phillips: Our Society is not in good condition.
We have not been successful in securing all of the physicians in the
county. It seems it will be impossible to secure some. The Society
is in perfect accord with the State Medical Society.

Forsyth — Dr. Haines: Our Society is in good condition, every
physician in the county being a member. We have monthly meetings,
and read papers, and discuss them.

IT. C. MEDICAL SOCIETY. 1ST

Franklin — Xo reijoit.

Gaston — Dr. D. A. Garrison : We have every licensed physician in
the county in our Association. We have a meeting every month at
which time we read papers and have intei'esting discussions. We have
a membership of 28, and there are from 7 to 20 present during each
meeting. They manifest considerable interest. We are getting on so
much better than before we organized. There are no phj'sicians there
taking other's cases. That prevailed there when I went. I am very
glad that is out. Everybody is in good fellowship.

Gates — Xo report.

Granville — Dr. S. D. Booth : The Society is not as good as might be.
Some of them do not pay their dues. The Secretary has been thinking
they would do so, but they are slow. The greatest trouble is in getting
our members to attend the meetings. I am the President, and I tried
the last meeting to get a new President. I was thinking that might
help the Society. They are all in good fellowship when they are there
and when they are not there. If you will tell me what to give my
members to get them to come out, I will try it. (Barbecue is sug-
gested. )

Greene — Xo report.

Guilford — Dr. Turner: We have a good Society. Since the County
Society became a unit with the State Society, we have built up one of
the largest County Societies in the State. We have nearly every
physician in the county in attendance. We have good attendance at
our meetings. We have several reports of cases that are very interest-
ing, indeed. We are growing in fellowship and grace, and the little
bickerings that are sometimes so common are disappearing. We don't
know whether or not another county is represented here by three
delegates or not. However, I am one of three sent here by Guilford to
represent her in the State Society. I am glad to be one of these three.
We are growing better and getting better, we are bound to get better,
we are getting closer together. All any of us need is to rub up against
each other. We get out among our patients and get a little careless,
but when we come out to the State Society and rub up against the
other fellow, it helps us. We always get some good out of a meeting.

Halifax — Xo report.

Harnett — Dr. J. W. Halford: We have a good, healthy Society. We
are doing very good work, we have monthly meetings, papers read and
discussed and occasionally, clinics. We have managed to arrange our
business affairs to be able to attend. We understand each other better.
Our Society includes every licensed man in the county. Tlie only reason
we do not have a larger attendance, is not because we do not have
barbecue.

Haywood — Dr. McCracken: W^e have a Society there in good fel-
lowship. We have when we meet interesting meetings and good papers
discussed.

Henderson — Xo report.

188 FIFTY-riFTII AA^NUAL SESSIOiiq'

Polk — Xo report.

Hertford — Xo report.

Hyde — Dr. Manx : We have an interesting Society in our county
and every active physician is a member except one.

Iredell-Alexander — Dr. McLaughlin: We have an organization in
our county that is some a-kin to Dr. Booth's. We have about 20 mem-
bers, I have been Secretary and Treasurer all the time, but have never
been able to get much out of it. We have several doctors who are not
members of the Society. The trouble that gives us most annoyance
is the members failing to attend, failing to be on hand in time. Some
members will come from away out in the country and be there waiting
while the other fellows who are right there at the Court-house, are
slow to come in. Some of the doctors are slow to pay. I send them
statements and do the best I can. Everything is harmonious.

Jackson — Xo report.

Johnston — Xo report.

Lenoir — Dr. Parrott: Lenoir has got her head in the air, and her
tail over the dashboard.

Lincoln — Dr. C. D. Thompson: We recently had all the active phy-
sicians of the county. Three of them have dropped out during the past
year, one of them resigned as President and has not returned to the
Society. We had the meeting monthly until recently when we decided
to meet bi-monthly. Our meetings are like the Iredell meetings. We
have one unlicensed practitioner in our county. He has been living
up there all his life and been practicing about 15 years. Recently when
a young doctor moved into his territory he didn't get any work. He
asks that the State Medical Association remedy this if possible. If
any action can be taken, it will be appreciated.

Dr. Booth: I am surprised that a man would dare practice In your
county without license. If any one comes into my covmty and attempts
to practice without license, it is reported to me. I am President of
the County Society. I report it to the Grand Jury and the Solicitor
and if it is necessary, I report it to the State Medical Society, who
takes its money out of its pocket and prosecutes the man. If that
county does not feel the necessity of employing lawyers, the State
Medical Society will do so. It does seem that the doctors would get
together and put public sentiment in such shape that that man would
not dare do that. I just wish some one would try it in Granville and
I would like to get on his track.

Dr. C. D. Thompson: This man is a very good practitioner. He
has applied himself to his studies and has been in college one year.
He lives among his friends and relatives and they are all in good
standing in the county. If we take action on this man, we are sure
that a rebound will be felt. This is the reason why we ask that the
State Medical Society take action.

K. C. MEDICAL SOCIETY. 189

Dr. Geo. W. Loxg: Every county in North Carolina is presumed to
have its court in session all the time. Everybody that practices medi-
cine is registered in the county. It looks like the courts would take
hold of this man. The party from Lincoln made a remark that is very
suggestive. Granville County is a high-toned county with good schools
and many more advantages that Lincoln County does not have. The
fact of the business is, the people there in Lincoln are not educated
up to the standard. There is nothing in the world to do, but go to the
Clerk of the Court and see if the man is registered. If he has his
name registered and has the certificate of the Clerk of the Court, he
has a right to practice.

Macon — No report.

Clay — No report.

Madison — No report.

McDowell — No report.

Mecklenburg — Dr. Monroe: Our Society meets every two weeks or
twice a month. There was some hesitation at first, but now we have a
good Society with 66 members. We were really entitled to 3 delegates.

Mitchell — No re^jort.

Moore — W. A. Monroe : Moore County has a very good Society. Meet-
ing every three months. Very good fellowship. We have papers read
and discussed at every meeting.

Montgomery — Dr. J. B. Shamburger: Our county has a very good
Medical Society. It has all 8 physicians in the county.

New Hanover — Dr. W'ood: New Hanover County is in the extreme,
I am sorry to say. We used to have a Society, but the conditions in
the county are now very unfavorable. It takes about 6 calls to get a
quorum, and if we do get a quorum, the meeting and discussions are
usually shut off by some fellow making a motion to adjourn. There
is good fellowship.

Northampton — H. W. Lewis: Nothing of interest to report. We
have about 12 doctors, and we meet about two or three times a year.
I tried to get them together before the State Society met, but could
not.

Onslow — Dr. J. L. Nicholson: We are few in numbers and live
very far apart. However, we have some features that we have heard
no other representatives mention. W^e very often invite some other
parties from other societies to be with us and have some interesting
subject for discussion.

Pamlico — Dr. D. A. Dees: We all stick together.

Camden and Dare — Dr. Walker: We have monthly meetings and
always have papers read and topics for discussion. We had a man
there who failed to get his license two years ago. We had him indicted
and tried. The Judge only fined him $25.00. He is making prepara-
tions to go away.

Pender — No report.

190 FIFTY-FIFTH AXKUAL SESSIO]^'

Perquimans — No report.

Pitt — No report.

Randolph — Dr. S. A. Hea'LY: I am very sorry to say it is in a
sickly condition. At one time we had a very nourishing Society. But
now about half of our physicians do not take any interest in it.

Richmond — No report.

Robeson — Db. A. B. Croom: We have a very thriving Society down
there. We have 28 members, all of the physicians in active practice
are enrolled with us. Two of the doctors are not members of our
Society. One of them does not do much; he has other business that
occupies his time. One resigned on account of the life insurance mat-
ters. We meet once every month. We keep certain statistics in the
hands of the Secretary in regard to attendance.

Rockingham — No report.

Rowan— Dr. R. V. Braavley: Every physician in the county is a
member of the Association. Everj'thing in good condition.

Rutherford — Dk. E. B. Harris: We meet every month. We usually
have two papers to discuss. We seldom miss a meeting. Before we
organized our Society there was some disagreement in the county, but
now all is agreeable. Now, every physician except two are active
members. We meet quarterly. We always have one good paper for
discussion. One member is appointed each meeting to prepare a paper
for discussion the following meeting. The only hindrance is that a
great number of the physicians are in too big a hurry to set off dis-
cussion of matters that come before the Society. I thinlc our Councilors
could do a good work in visiting other societies.

Scotland — No report.

Stanly — Thos. A. Hathcock: Our Society is not doing very active
work. We are meeting about every two months, but not regular.
Every doctor is supposed to be a member. The Society has been bene-
ficial. A better feeling is prevalent than formerl^y and there is more
evenness among the fellows. Altogether, the Society is very beneficial.
One man tried to practice in Stanly without license but it got so
warm for him that he had to move. There is one itinerant doctor who
runs down in the country and does some work.

Stokes — No report.

Surry — Dr. S. T. Flippin: I was just thinking we had a very
healthy Society, but since hearing the reports of some of the other rep-
resentatives, I am inclined to think that ours could do better. It is very
interesting to me. I have to drive over about twenty miles of the roughest
road a man ever went over to get there and when I do get there, I have
to go round and hunt up some of the other fellows before we can have
a meeting. Now, that makes it very interesting indeed, to me. They
are so awful busy there in the town. There must be more sickness
there than in the country. I can't report like some of them have. We
have three physicians in our county who are not members, nor, indeed

N, C. MEDICAL SOCIETY. 191

will they ever be. One of them is about 70 years old, but still he
practices medicine. One is the son of this man and he has his back up
against organizations because his daddy don"t like 'em. I am mighty
glad I can report the condition of our Society better than before.

Swain — Xo report.

Transylvania — Xo report.

Union — Dr. Blair: Every doctor excepo one m tiie county is a mem-
ber of the Society in good fellowship.

Vance — Dr. J. H. Tucker: Society is in good condition, we have
monthly meetings.

Wake — Dr. Lewis: The interest is good on the part of the country
members, but feeble on the part of the city members. We have monthly
meetings, discussions, and once a year, we have a barbecue. There is
good fellowship.

Washington — Xo report.

Wayne — Xo report.

Wilkes — Dr. J. Q. Myers: Our Society was organized about five
years ago and has been doing good work ever since. We meet every
month. We missed some meetings last winter during the bad weather.

Wilson — Xo report.

Yadkin — Dr. T. W^. Shore: The Society is in very good condition,
all physicians belong to it except one.

Yancey — Xo report.

Buncombe — Dr. Burroughs: We have 56 paid-up members. Meetings
twice every month. We get after every man practicing without license
and soon drive him over the line. We have successfully fought the
insurance matters.

Representative from Surry — Dr. Flippex: I wanted to say that
there is a so-called cancer doctor who comes down into Surry every
once in a while and injects medicine into every little tumor, and as a
result the undertaker has the next job.

There being no further reports President announced the
selection of a K'ominating Committee in order and declared
a recess of a few minutes in which to allow the members of
each district to make their selection.

The session was resumed and the House duly appointed
the following as a !N"ominating Committee :

First District — H. D. Walker.
Second District — S. T. Xicholson.
Third District — J. L. Xicholson.
Fourth District — M. Bolton.
Fifth District — J. W. Halford.
Sixth District — Jno. Hill Tucker.

192 FIFTT-FIFTH ANNUAL SESSION

Seventh District — E. C. Eegister. ,

Eighth District — Tno. Q. Myers.
Ninth District — A. A. Kent.
Tenth District — T. E. W. Brown.

The names read were declared elected and it was requested
that tliej get together and be ready to report at the session
the following morning.

New Business. — l^one.

Reports of Counties. — ISTone.

Unfinished Business. — ISTone.

Dr. Kent : I think it would be well if some place could
be designated as a place where we could meet and organize the
l^ominating Committee. I think it would be well for some
place to be suggested where we could come together as a nom-
inating committee.

The President : It is suggested that the committee meet
to-night at half-past eight o'clock at the Zinzendorf Hotel, in
room Xo. 316.

Motion to adjourn till the following morning at 8 :30
o'clock. Motion carried.

House adjourned till 8 :30 a. m., June 17, 1908.

Winston-Salem^ June 17, 1908.
Wednesday, 9 a. m..

House of Delegates met. President Way in the chair. The
report of the IN'ominating Committee was received and
adopted.

The Committee's report was presented by Dr. A. A. Kent:
The Nominating Committee, which was elected on yester-
day, beg leave to submit the following as a result of its de-
liberation :

For President — Dr. J. F. Highsmith, Fayetteville.

For First Vice-President — Dr. C. M. Poole, Salisbury.

For Second Vice-President — Dr. D. A. Garrison, Bessemer City.

For Third Vice-President — Dr. D. A. Dees, Bayboro.

Zjq-. C. MEDICAL SOCIETY. 193

Orator. — Dr. Chas. W. !Moseley, Greensboro.

Essayist. — Dr. W. L. Dunn, Asheville.

Leader of Debate.— Br. L. B. Newell, Charlotte.

Counoilor Fourth District. — Dr. E. T. Dickinson, Wilson.

Delegates to A. M. A. — Dr. J. Howell Way, Waynesville — two years;
Dr. A. J. Crowell, Charlotte — two years; Dr. D. A. Stanton, High
Point — one year.

Alternates. — Dr. P. J. Thomas, Wilmington; Dr. D. S. George, INIar-
shallburg; Dr. H. H. Dodson, Greensboro.

Finance Committee.— Br. H. S. Lott, Winston; Dr. R. E. L. Flippin,
Pilot Mountain; Dr. J. M. Blair, Monroe.

Obituary Committee. — Dr. Chas. A. Julian, Thomasville; Dr. A. A.
Kent, Lenoir; Dr. S. T. Nicholson, Washington.

Committee on Publication. — Dr. E. C. Register, Charlotte; Dr. W. H.
Wakefield, Charlotte; Dr. D. A. Stanton, High Point.

Committee on Public Policy and Legislation. — Dr. J. F. Highsmith
(ex officio Chmn.) ; Dr. R. H. Lewis, Raleigh; Dr. Geo. G. Thomas,
Wilmington; Dr. Albert Anderson, Raleigh; Dr. D. A. Stanton, High
Point (ex officio).

Committee on Scientific Work. — Dr. John Bynum, Winston; Dr. W. S.
Rankin, Wake Forest; Dr. D. A. Stanton (ex officio).

Delegates to Mississippi Valley Medical Association. — Dr. W. 0.
Spencer, Salem; Dr. William R. Kirk, Hendersonville; Dr. M. L.
Stevens, Asheville; Dr. Cyrus Thompson, Jacksonville; Dr. W. D.
Pemberton, Concord; Dr. J. H. Shuford, Hickory.

Delegates to Virginia Medical Society. — Dr. J. L. Doughton, Sparta;
Dr. J. J. Phillips, Selnia; Dr. J. M. Williams, Warsaw; Dr. F. H.
Gilreath, North Wilkesboro; Dr. S. C. Highway, Murphy.

Delegates to South Carolina Medical Society. — Dr. W. D. Witherbee,
Charlotte; Dr. D. N. Dalton, Winston; Dr. J. F. McKay, Buie's Creek;
Dr. A. W. Disosw^ay, New Bern; Dr. Earl Grady, Tryon.
^ext Place of Meeting. — Asheville.

Chairman Local Committee of Arrangements. — Dr. T. E. W. Brown.
Time of Meeting. — June 15th, 1909.

The report of the dominating Committee was accepted.

J. M. Parrott moved that the Treasurer of the Society bu
instructed to pay on order of the Legislative Committee or
Councilors, approved by the President, such expenses as may
be incurred by the Committee or Councilors in the legitimate
discharge of their duties. This resolution was discussed by
Drs. Way, Lewis, Parrott, Manning and Flippin.

After much discussion the resolution passed.

The following amendment to the Constitution was offered
by Dr. J. T. Burrus, ''An amendment offered to amend Art.
13

194 FIFTY-FIFTH ANNUAL SESSION

VIII, sec. 3, of the Constitution, which makes it read as fol-
lows" :

The officers of this Society shall be elected by ballot at a conjoint
session on the morning of the third day of the annual session, a
majority of votes cast being necessary to elect. No person shall be
elected to any office who is not in attendance upon the annual session,
and who has not been a member of this Society for the past three years.
Any nominee for the office of President shall have been an active mem-
ber of this Society for five years including the year of his election,
shall have attended two of three meetings immediately preceding his
nomination including the meeting at which he is nominated, and shall
be a member in good standing at the time of his nomination.

(Signed.) Dr. J. T. Burrus.

Amendments to the Constitution offered in the House of
Delegates at the Winston-Salem meeting in 1908, by A. A.
Kent

Amend Article IX, sec. 1, second line by inserting the words '"by
the members of the Society in the general meeting" after the words
''by ballot."

Amend Article IX, sec. 3, third line by inserting the words "by the
members of the Society in the general meeting" after the words "by
ballot."

Amend Article XI, by inserting the words "present and voting" after
the word "Societj^' in the seventh line.

On motion of Dr. Parrott (and same was carried) it was
ordered that such members as have complied with sec. 5; Art.
IV, of Constitution, be made honorary fellows.

N^ames reported as eligible to go on list of Honorary Fel-
lows:

Geo. W. Long, Graham, Alamance County — Year joined, 1877.

R. H. Speight, Whitakers, Edgecombe County, 1875.

R. J. Noble, Selma, Johnston County, 1878.

W. H. Whitehead, Rocky Mount, Nash County, 1875.

D. W. Bullock, Wilmington, New Hanover County, 1875.

L. H. Hill, Germanton, Stokes County, 1877.

L. .J. Picot, Raleigh, 1875.

R. H. Lewis, Raleigh, Wake County, 1877.

J. W. McGee, Raleigh, Wake County, 1865.

W. H. H. Cobb, Goldsboro, Wayne County, 1878.

L W. Faison, Charlotte, 1878.

C. E. Moore, Wilson, 1875.

Henry Tull, Kinston, 187G.

N. C. MEDICAL SOCIETY. 195

Motion was made and carried that the resolutions of Presi-
dent Way relative to narcotic prescribing by physicians be
published in the State papers. (See resolution.)

The House of Delegates instructed the Secretary to have
a photograph of the late Dr. P. L. Murphy made and inserted
in the pages of the Transactions.

Motion by Dr. Parrott that $1,000 be appropriated to be
used by the Legislative Committee. This motion was dis-
cussed by Drs. Lewis, Way, and others. Motion was with-
drawn with an understanding that the officers would approve
proper bill for same.

There being no further business the House of Delegates
adjourned sine die.

D. A. STA^^TO]^^^ J. Howell Way^

Secretary. President.

FORTY-SIXTH ANNUAL SESSION

OF THE

BOARD OF MEDICAL EXAMINERS

OF THE

STATE OF NORTH CAROLINA

Winston-Salem. N. C. June 10 to 18, 1908

The forty-sixth regular annual session of the Board of
Medical Examiners of the State of jSTortli Carolina convened
in Winston-Salem, ]^. C, on June 10, 1908, and remained
in regular session until June 18, 1908.

The entire membership were present, including Drs. A. A.
Kent, of Lenoir; G. T. Sikes, of Grissom, M. H. Fletcher,
of Asheville; James M. Parrott, of Kinstou; Chas. O'll.
Laughinghouse, of Greenville ; Frank H. Russell, of Wilming-
ton, and J. T. J. Battle, of Greensboro.

The terms of office of the entire Board expired at this ses-
sion and a new Board was elected by the State Medical So-
ciety on June 17, 1908.

In the following pages are to be noted the questions used
by the Board at this examination, the applicants and various
other data relative to the session.

ANATOMY.

JAMES M. PARROTT, M.D., KINSTON, N. C.

1. After the brachial artery is ligated in the upper third of the arm
by what branches is the collateral circulation carried on?

2. Give the boundaries of a femoral canal.

3. Locate the fissure of Rolando (surface markings).

4. Name the contents of Scarpa's triangle.

5. At what point would you trephine for intra-cranial hemorrhage
from the middle meningeal artery.

6. give the apparent (superficial) and deep origin of the 3d cranial
nerve (motor oculi).

7. Mention the contents of the left lumbar region (abdomen).

8. Into what do the ends of the Eustachian tube open?

jst. c. medical society. 197

9. Describe the female urethra. (Do not give its relations or his-
tology ) .

10. Describe the odontoid process of the axis and name the bone or
bones with which it articulates.

X. B. Answer only 8 questions.

SURGERY.

CHAS. O'h. LAUGHIXGHOUSE, M.D., GREENVILLE, X. C.

1. Surgical shock. Give Prophylaxis.

2. Hemorrhage. Give constitutional symptoms.

3. Ranula. Describe it.

4. Malignant oedema. Describe it.

5. Myxomata. Give seats of predilection.

6. Periostitis. Give diagnostic symptoms.

7. Potts fracture. How wovild you dress it? And whj'?

8. Torticollis. Give operative procedures for relief for same.

9. Hip joint disease, second stage. Give diagnostic symptoms.

10. Phlyctenuler keratitis. Treatment.

JMATERIA MEDICA.

F. H. RUSSELL, .M.D., WILMIXGTOX, X. C.

1. Name four (4) remedies most often used hypodermatically. Give
doses.

2. What is a mydriatic? Name one.

3. What is an antidote? An antagonist?

4. Name the preparation of Bismuth. Give doses.

5. Give physiological action of Cinchona.

6. Name the preparations of Iodine. Give doses.

7. Name three (3) useful Emetics. Give doses.

8. Give uses of Salicylic acid.

9. Write a prescription for a tonic-laxative pill containing four (4)
ingredients.

10. Write a prescription for Tertiary Syphilis, containing three (3)
ingredients.

EXAMINATION ON PRACTICE OF MEDICINE.

BY M. H. FLETCHER. M.D.. ASHEVILLE, X. C.

1. Give differential diagnosis between Acute General Miliary Tuber-
culosis and Typhoid Fever.

2. Name the most frequent complications of Pneumonia.

3. Name causes of Heraatemesis.

4. Define Aphasia, Pellagra, Chlorosis.

5. Give relative frequency and etiology of :Mitral Incompetency.

6. Give differential diagnosis between Gout Arthritis Deformans.

7. Give symptoms of Acute Nephritis.

198 FIFTY-riFTH ANNUAL SESSION

8. Define Tabes Dorsalis. Give characteristic symptoms, etiology.

9. How would you distinguish Ascites from an Ovarian cyst.

10. Write one and only one Rx. for temporary relief of Migraine.

CHEMISTRY AND THE DISEASES OF CHILDREN.

G. T. SIKES, M.D., GRISSOM, N. C.

1. What is the standard of chemical comparison?

a Give combining Aveight and density.

2. What are the two great divisions of chemistry?

a Wherein is the chief difference?

3. What is Ozone?

a Give formula.

4. What is Gun-cotton?

a How is it made?

5. What is Carbon?

a What is the purest form?
G. Define Measles.

a What is period of incubation?

7. Define Mumps.

a What are the complications?

8. Define Dysentery.

a Give treatment.

9. What is Jaundice?

a Give etiology.

10. Define Croup.

a Give prognosis.

OBSTETRICS AND GYNECOLOGY.

A. A. KENT, M.D., LENOIR, N. C.

\. Name (a) the causes of ante-partum hemorrhage in pregnancy;
(b) post-partum hemorrhage.

2. What are the means that may be employed to cause firm contrac-
tion of the womb after completion of the third stage of labor?

3. If the umbilical cord should become severed too close to the
abdominal wall of the infant to be tied, and there should be hem-
orihage from it, how would you treat it?

4. Give (a) the indications for Cesarean section, (b) the contra-
indications.

5. How would you treat dysmenorrhoea dvie to congenital stenosis
of the cervix?

G. Name the forms of fistula that are met with in the female genital
tract.

7. Name (a) the benign neoplasms of the uterus; (b) the malignant
neoplasms of the uterus.

8. Under what circumstances, if any, would you (a) irrigate the
abdominal cavity after an ovariotomy; (b) employ drainage after an
ovariotomy?

X. C. MEDICAL SOCIETY. 199

Note: — Do not undertake to write all vou know about the subjects
named in these questions. Most of them should be answered in one
to five lines each across your book, the longest may be answered in
twelve lines. Do not write more than one page in answer to any one
of them.

PHYSIOLOGY AND HYGIENE.

J. T. J. BATTLE, il.D., GREENSBORO.

1. Describe normal human blood.

2. Define reserve, residual, complemental and tidal air, give average
quantity of each.

3. If Gasserian ganglion were removed, state results.

4. Describe chyle and how introduced into the general circulation.

5. Give the function of the bile; where formed; mention its two
acids and two pigments.

6. Describe the factors which cause the heart sounds.

7. Describe the structure and functions of the skin.

8. How can malaria be eliminated from any locality.

9. How does milk, water and food become contaminated and produce
typhoid fever?

10. What is a disinfectant? Mention two physiological agents, two
metallic, and two nonmetallic ones.

200

riFTY-FIFTir ANNUAL SESSION

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N. C. MEDICAL SOCIETY. 205

One liimdred aud thirty-two applicants appeared beforb the
board. Xinetv-three successfully passed the examinations
and were duly licensed. Ten were granted license through
reciprocity. Twenty-nine applicants w^ere rejected.

Three successful applicants tied for the honors of making
the highest grade — that of each being 95 1-7. Their names
are : A. J. Terrell, Old Fort, X. C. ; John Wilson McCon-
nell, McConnellsville, S. C. ; Thurman D. Kitchin, Scotland
Xeck, X. C.

The next highest grade was 93^, made by Charles Solo-
mon Lawrence, Mount Airy, X. C.

The names of the successful applicants are as follows :

Baird, Jno. M., Mars Hill.

Baird, David E., Sagno.

Berry, John, Chapel Hill.

Bizzell, Thos. M., Goldsboro.

Bolles, Chas. P., Wilmington.

Chaney, Thomas M., Old Fort.

Covington, Piatt W., Wadesboro.

Dees, Ralph E., Grantsboro.

Dodds, S. A., Salisbury.

Edwards, Slocumb R., Siler City.

Engel, William R., Tryon.

Frazier, H. T., Asheville.

Freeman, Robert H., Wake Forest.

Gardner, Garrett D., Ivey.

Garrenton, Cecil, Coinjock.

Green, William W., Franklinton.

Harris, D. W., Fayetteville.

Hunnicutt, William J., Asheville.

Irwin, Ham. C, Roanoke Rapids.

James, W. D., Laurinburg.

Jett, S. G., Reidsville.

Johnson, Wingate M., Raleigh.

Kerr, John D., Jr., Clinton.

Kitchin, Thurman D., Scotland Neck,

Lane, P. P., Wilson.

Lassiter, Ed. W., Rich Square.

Lawrence, Charles S., Mount Airy.

Ledbetter, P. B., Pisgah Forest.

McConnell, John W., McConnellsville, S. C,

Mclver, E. McN., Jonesboro.

McKee, John S., Raleigh.

206 FIFTY-FIFTH ANNUAL SESSION

McLean, Allen, Lavirinburg.

McMurray, H. E., Sharon, S. C.

McPherson, R. G., Snow Camp.

Mann, J. E., Lake Landing.

Maynard, William X., Hillsboro.

Mock, F. L., Winston-Salem.

Monk, Geo. M., Raleigh.

Mudgett, W. C, Southern Pines.

Nichols, A. F., Roseboro.

Pate, Fred. J., Gibson.

Pepper, John C, Kernersville.

Perry, A. H., Raleigh.

Potts, Robert M., Fort Mill, S. C.

Powell, J. A., Harrellsville.

Reid, Jas. W., Lowell.

Ritch, John C, Behvood.

Robertson, William R., Burnsville.

Ross, George F., Philadelphia.

Royster, Thomas H., Oxford.

Rucher, A. A., Rutherfordton.

Scofield, E. J. S., Wapperings Falls, N. Y.

Shoate, B. O., Sparta.

Shubert, L. H., Enfield.

Smith, John M., Louisburg.

Smith, P. T., Anna.

Smith, T. H., Liberty.

Spoon, A. 0., Haw River.

Stafford, W. W., Elizabeth.

Taylor, James T., Raleigh.

Terrell, A. J., Old Fort.

Thornton, Miss Irene, Fayetteville.

Timberlake, Richard E., Youngsville.

Upchurch, R. T., Apex.

Wakefield, H. A., Charlotte.

Walters, Charles M., Burlington.

Ward, V. A., Wilson.

Watson, John B., Raleigh.

Webb, S. E., Browns Summit.

Wellborn, William R., Cold Ridge.

Whitney, L. M. D., Monroe.

Wilkinson, Charles E., Greensboro.

Wilson, W. P., Pine Hall.

Winslow, William T., Democrat.

Young, C. R., Angier.

COLORED.

Avent, Frank, New Bern.
Carter, Ed. R., Winston,

K". C. MEDICAL SOCIETY. 207

Eiwiii, H. J., Morganton.
Fisher, Charles E., Raleigh.
Henry, John Robert, Beaufort.
Mitchell, L. L., Ahoskie.
Mitchener, William A., Raleigh.
Page, F. T., Durham.
Perry, M. X. L., Fayetteville.
Portis, E. S., Louisburg.
Ray, A. H., Raleigh.
Styron, N. H., Jr., New Bern,
Thornton, F. J., Jr., Raleigh.
Torrence, William G., Asheville.
W^inston, George L., Rocky Mount.

The following were granted license under the reciprocity
clause :

Bissell, Helen W., Allegheny.
Brown, V. J., Ogden.
Burns, A. B., Statesville.
Carr, R. L., Wallace.
Harrison, E. H., Wake Forest.
Hooper, J. O., Fletcher.
McCotter, St. Elmore, Mayboro.
Shepherd, F. A., Liberty.
Smith, J. T., Salisbury.
Watkins, M. J., Mclver.

On the conclusion of the duties of this session the labors
and responsibilities were placed upon the worthy shoulders
of a new board, elected by the State Medical Society on
June 17, 1908. This board met and organized as will be
noted on the following pages.

With appreciation of the honors enjoyed.
Respectfully submitted, for the board,

G. T. SiKES, Sec.-Treas. A. A. Kent, President.

Minutes of the Newly Elected Board of Medical

Examiners at Winston-Salem, N. C,

June 18, 1908

The State Board of Medical Examiners, elected to serve
during the next six years (1908-1914), have met and organ-
ized with the following results :

Dr. Jno. C. Rodman, Washington, President, Chemistry and Diseases
of Children.

Dr. Lewis B. MeBrayer, Asheville, Surgery.

Dr. Wm. W. McKenzie, Salisbury, Anatomy and Histology.

Dr. John Bynuni, Winston-Salem, Obstetrics and Gynecology.

Dr. J. L. Nicholson, Riehlands, Physiology and Hygiene.

Dr. H. H. Dodson, Greensboro, Practice of Medicine.

Dr. Benj. K. Hays, Oxford, Secretary-Treasurer, Materia Medica.

"Requisitions for Eeciprocity" w^ere adopted by the board.
The next session ordered to be held at Asheville, N. C,
June 9, 1909.

B. K. Hays^ Jno. C. EodmaN;,

Secretary-Treasurer. President.

BOARD OF MEDICAL EXAMINERS OF THE STATE OF NORTH

CAROLINA.

J. C. RODMAN, M.D.. PRESIDEXT, WASHINGTON.
BENJ. K. HAYS, M.D., SEC.-TREAS., OXFORD.

J. C. Rodman, INI.D., Washington, Chemistry and Diseases of Children.

L. B. MeBrayer, M.D., Asheville, Surgery.

W. W. McKenzie, M.D., Salisbury, Anatomy and Pathology.

H. H. Dodson, M.D., Greensboro, Practice of Medicine.

John Bynum, M.D., Winston-Salem, Obstetrics and Gynecology.

J. L. Nicholson, M.D., Riehlands, Physiology and Hygiene.

Benj. K. Hays, M.D., Oxford, Materia Medica and Therapeutics.

The next annual meeting will be held at Asheville, June 9, 1909.

MEDICAL LICENSE.

An applicant for license to practice medicine in North Carolina must
appear before the Board of Medical Examiners in regular session and
present a certificate of good moral character, attested by two persons

N. C. MEDICAL SOCIETY. 209

known to the board, a diploma from a medical college in good standing
or a license from some other State, and must deposit ten dollars with
the Secretary of the board. He will then be examined upon the follow-
ing branches of medicine: Anatomy, Physiology, surgery, Pathology,
Medical Hygiene, Chemistry, Pharmacy, Materia Medica, Therapeutics,
Obstetrics and the practice of medicine.

He must make an average of eighty per cent upon all the branches,
and he must not fall below thirty-five per cent upon any one branch.

TEMPORARY LICENSE.

An applicant for temporary license must appear before two members
of the Board of Medical Examiners and present a certificate of good
moral character, a diploma from a medical college in good standing,
and must pay a fee of five dollars. He must then stand a satisfactory
oral examination.

A temporary license continues in force only until the next regular
meeting of the board, and is never granted but once to the same ap-
plicant.

REQUISITION FOR RECIPROCITY.

1. The applicant must have a diploma from a medical college requir-
ing a three years course of study for such degree.

2. He must have license from a State Board of Examiners requiring
the same per cent as this State, which is 80.

3. He must present a sworn afiidavit from two practicing physicians
as to his professional standing in his community, the burden of proof
resting upon the applicant.

4. He shall attend the meeting of the board at the time of application
and make the same in person.

5. He shall pay a fee of ten dollars for such license.

6. He must not have failed before the North Carolina Board.

7. He must have been in actual practice for five years in the State
from which he comes.

LAWS OF NORTH CAROLINA RELATIVE TO THE PRACTICE OF

MEDICINE.

(Revisal of 1905.)

Sec. 4494 — Board of Examiners to elect officers — The Board of Medi-
cal Examiners are authorized to elect all such officers, and to frame
all such by-lays as may be necessary, and in the event of any vacancy
by death, resignation or otherwise, of any member of said board, the
board, or a quorum thereof, is empowered to fill such vacancy.

Sec. 449.5. — Board of Examiners, Meetings of — The Board of ]\Iedical
Examiners shall assemble at the same time and place when and where
the Medical Society assembles, which Society shall assemble at least

210 FIFTY-FIFTH ANNUAL SESSION

once in every year at such time and place as the said Society at its
next preceding meeting shall have fixed; and the said board shall
remain in session from day to day until all applicants who may present
themselves for examination within the first five days after its meeting
shall have been examined and disposed of: Provided, that the board
may at its discretion, meet not more than one week before the said
Society, but always in the same place; and that one additional meeting
in each j'ear may be held at some suitable point in the State, if deemed
advisable.

Sec. 4498. — Applicants for License Examined. — It shall be the duty
of the said board to examine all applicants who shall exhibit a diploma,
or furnish satisfactory proof of graduation from a medical college in
good standing requiring an attendance of not less than three years, and
supplying such facilities for clinical instruction as shall meet the
approval of the said board, for license to practice medicine or surgery,
or any of the branches thereof, on the following branches of medical
science: Anatomy, Physiology, Surgery, Pathology, Medical Hygiene,
Chemistry, Pharmacy, Materia Medica, Therapeutics, Obstetrics and
the practice of medicine, and if on such examination they be found
competent, to grant to each applicant a license or diploma, authorizing
him to practice medicine and surgery, or any of the branches thereof.
Five members of the board shall constitute a quorum and four of those
present shall be agreed as to the qualification of the applicant: Pro-
vided, that the requirement of three years' attendance at school shall
not apply to those graduating prior to January first, nineteen hun-
dred: Provided fvirther, that license or other satisfactory evidence
of standing as a legal practitioner in another State shall be accepted
in lieu of a diploma and entitle to examination.

CHAPTER 890 PUBLIC LAWS OF NORTH CAROLINA

An Act to Amend Section 4498 of the Revisal of 1905, by Adding
A Subsection Marked (a) Thereto for Enlarging the Powers
OF THE Board of Medical Examiners in Granting License to Ap-
plicants to Practice Medicine.

The General Assembly of North Carolina do Enact:

Sec. 1. That section four thousand four hundred and ninety-eight
of The Revisal of one thousand nine hundred and five be amended by
adding a subsection marked (a) : "That the Board of Medical Examiners
shall in their discretion issue a license to any applicant to practice
medicine and surgery in this State without examination if said ap-
plicant exhibits a diploma or satisfactory proof of graduation from a
medical college in good standing requiring an attendance of not less
than three years and a license issued to him to practice medicine and
surgery by the Board of Medical Examiners of another State."

N. C. MEDICAL SOCIETY. 211

Sec. 2. This Act shall be in force and effect from and after its ratifi-
cation.

In the General Assembly read three times and ratified, this the Uth
day of March, A. D., 1907.

(Revisal of 1905.)

Sec. 4499. — Temporary License. — To prevent delay and inconvenience,
two members of the Board of Medical Examiners may grant a tem-
porary license to any applicant who may comply with the requirements
as to graduation prescribed in the preceding section, and make report
thereof to the next regular meeting of the board: Provided, such
temporary license shall not continue in force longer than the next
regular meeting of the board, and such temporary license shall in no
case be granted aft«r the applicant has been refused a license by the
Board of Medical Examiners.

Sec. 4501. — License Fee. — The board shall have power to demand of
every applicant thus licensed the sum of ten dollars before issuing a
license or diploma, and the sum of five dollars for each temporary
license, to be paid to the Secretary of the board.

Sec. 4503. — Board May Rescind License. — The said board shall have
the power to rescind any license granted by them when upon satisfac-
tory proof it shall appear that any physician thus licensed has been
guilty of grossly immoral conduct.

The North Carohna Association for the Prevention of
Tuberculosis- -Third Annual Session Held in Win-
ston, N. C, at Noon, Thursday, June 18, 1908.

At 12 o'clock Dr. C. A. Julian, Vice-President, called that
body to order in the lobby of the Hotel Zinzendorf , Winston-
Salem, N. C.

Dr. W. L. Dunn, of Asheville, IST. C, was elected Presi-
dent; Dr. John Eoy Williams, of Greensboro, ]^. C, was
elected Vice-President ; Dr. C. A. Julian, of Thomasville, K.
C, was elected Secretary and Treasurer.

The following members of the Association were present

at the meeting:

Drs. L. B. Morse, John L. Williams, W. C. Bronson, H. C. Weaver,
W. L. Dunn, H. T. Bahnson, J. Howell Way, C. A. Julian, Richard H.
Lewis, Wm. M. Jones, Isaac M. Taylor, J. F. Highsmith, Hon. Clement
Manly, Drs. Wm. Bolton, P. E. McFayden, E. M. Summerel, D. A.
Dees, A. W. Knox, J. B. Smith, J. A. Turner, J. R. Reitzel, Chas. R.
Wharton, E. C. Laird, W. P. Whittington, J. C. Grady, H. H. Briggs,
W. S. Rankin, A. B. Croom, J. L. Hanes, J. P. Turner, F. 0. Rogers,
C. F. Harper, H. H. Dodson, J. Allison Hodges, L. B. McBrayer,
Philip Morris, A. L. Flanders, Francis Duffy, R. G. Buckner, J. W.
Long, A. A. Kent, W. P. Beall, J. T. Burrus, G. E. Jordan, C. A.
Andrews, W. P. Reeves, J. M. Reece, H. A. Barnes and D. A. Stanton.

The Association was organized May 30, 1906, by the com-
mittee appointed by the President of the North Carolina
Medical Society, under resolution offered at the 1905 session.
The purpose of the Association as stated in Article II of the
Constitution of the Association is the Prevention of Tuber-
culosis :

a. By the study of the disease in all of its forms and relations.

b. By the dissemination of knowledge concerning its cause, pre-
vention and treatment, and by supplementing the work of the State
Board of Health in this cause.

c. By such other means as may from time to time be deemed advisa-
able.

This Association is bending all energies to stimulate a
wide interest in this most important branch of preventive
medicine.

N. C. MEDICAL SOCIETY. 213

A number of gentlemen spoke of the work that the Asso-
ciation should undertake, and plans were advanced for mak-
ing the Association one of the most effective working bodies
in the State.

On motion of Dr. Richard H. Lewis, of Raleigh, all mem-
bers present were elected delegates to the International Con-
gTess on Tuberculosis at the meeting in Washington, D. C,
September 21st to October 12th.

On motion of Dr. W. L. Dunn, Drs. Chas. Minor, S. W.
Battle, M. L. Stevens, Paul Ringer, of Asheville ; Drs. Thos.
A. Mann, of Durham; Wm. R. Kirk, Hendersonville ; D.
A. Dees, Bayboro, were elected delegates to the International
Congress on Tuberculosis.

We have passed the stage of experiment, and each meeting
in the future should show a respectable array of measures
successfully carried out and the broadening of our sphere of
influence for good.

The Association adjourned to meet upon call of the officers.

Chas. A. Julian^ M.D.,

Secretary.

The North CaroUna Board of Health

G. G. Thomas, M.D., President Wilmington.

Thomas E. Anderson, M.D Statesville.

J. Howell Way, M.D Waynesville.

W. 0. Spencer, M.D Winston-Salem.

Edward C. Register, M.D Charlotte.

David T. Tayloe, M.D Washington.

J. A. Burroughs, M.D Asheville.

J. L. Ludlow, C.E Winston-Salem.

Richard H. Lewis, M.D., Secretary and Treasurer Raleigh.

ANNUAL MEETING, JUNE, 1908

The annual meeting of the Board was held at the Zinzeu-
dorf Hotel, Winston-Salem, on the evening of June 16th, all
the members except one being present. Dr. Thomas E. An-
derson was elected a member of the State Board of Embalm-
ing, to succeed Dr. Edward C. Register, whose term expired
and who declined a reelection.

Dr. Shore, Director of the State Laboratory of Hygiene,
was present by invitation. After consultation with him the
Board ordered the inauguration as soon as possible of the
prophylactic treatment of hydrophobia, in accordance with
the act of the last Legislature.* The employment of an as-
sistant bacteriologist was authorized.

On the following day (Wednesday) the conjoint session
with the State Medical Society was held. The attendance
was good and the interest in the proceedings manifest. Dr.
Stiles, of the United States Public Health Service, upon our
invitation, read a very interesting and valuable paper on
''The Medical Influence of tlie Xegro in Connection with
Anemia in the White." Also, upon our invitation. Dr. Tait
Butler, State Veterinarian, read a paper on "Milk Supplies
in Relation to the Public Health." This was extremely prac-
tical and useful, and, supplemented by additional remarks
in the doctor's earnest and vivacious style, evidently made
an impression.

*Pursuant to instructions of the Board, the treatment was begun in
the laboratory at Raleigh on July 1, 1908.

K". C. MEDICAL SOCIETY. 215

Annual Report of the Secretaky of the North Carolina Board

OF Health.

R. H. lewis, m.d.

May 20, 1907— May 20, 1908.

The health conditions of our State during the past year have been
marked by nothing out of the common run, and the work of your
Secretary has been chiefly routine. There have been some small
epidemics of typhoid fever and an investigation by the board was re-
quested by County Superintendent of Health Evans of one in Councils,
in Bladen County, and by Mayor Montgomery of Reidsville of an out-
break in that town. The former was investigated by President Thomas
and the latter by Engineer Ludlow. Their respective reports are ap-
pended.

Tuberculosis has lost nothing in importance or interest. Our dis-
tribution of literature on the subject has, I believe, borne fruit in the
education of the people as to the best methods of preventing its
spread. In August last, at the request of the authorities, a committee
of the board visited the State Hospital at Morganton and advised
with the management as to the location of special quarters for tuber-
culous patients. Their report is appended.

Although not under the control of the Board of Health its Secre-
tary is, ex officio, a member of the Board of Directors of the State
Sanatorium for Tuberculosis and a review of the health conditions of
the State would not be complete without reference to it. Its establish-
ment was authorized by the last Legislature, but it has been un-
avoidably delayed by the inability to secure a site suitable to the per-
manent establishment of so important an undertaking. Fortunately
the necessary abandonment of one or more locations fixed upon, owing
to the inability to secure a sound title, finally resulted in the selection
and purchase of as nearly an ideal site as can be well imagined.
Situated in the sand hills of Cumberland Coimty about eight miles
from Aberdeen, it is traversed by the Aberdeen and Rockfish Rail-
road, and is, therefore, easy of access. The purchase contains about
nine hundred acres and at its highest point, which has been selected for
the location of the building, overlooks a wide panoramic view of at
least three-fourths of a circle of miles upon miles of rolling pine
forest. Work has been begun on the buildings and it is hoped that
patients can be received in the early fall, I am told by Dr. Brooks,
the Superintendent.

The International Congress on Tuberculosis, which is to meet in
Washington, September 21st to October 12th is an event of world-wide
interest and will well repay a visit. I hope that many of our health
officers and physicians will attend.

Smallpox has been slightly more prevalent than during the preced-
ing year, the record being 2011 cases with 8 deaths against 1968 cases
and 6 deaths in 1906-07. During the past year the disease has been
much more prevalent among the whites than among the negroes, which
is just the reverse of the year before. To state it accurately: In

216

FIFTY-FIFTH ANXUAL SESSION

1906-07 there were 620 white cases with 2 deaths and 1348 colored
cases with 4 deaths; while during the past year there were 1168
white cases with six deaths and 843 colored cases with 2 deaths. The
number of counties infected was just the same in each year, 48.
Owing to its continued mildness and the fact that it has become such
an old story, just ten years old, it produced little concern and practi-
cally no interference with business. The following is a tabulated
statement by counties:

SMALL-POX REPORT.

Number of Cases.

Number of Deaths.

Counties.

White.
Colored.

o
p

Alamance*

75 60
6

2 5
6

135

111

200

206

181

225

80
6
20
39
130
3
20

Alleghany

Beaufort

Bertie

Buncombe

Binke _

Cabarrus

89 22
1

20 i 3
100 100

8 '

2 1
1

32 17

Catawba.

Chatham

Chowan

Cleveland

Columbus

Cumberland .

Currituck

Davidson

Davie

55
1

Durham.

Edgecombe*

14 192
6

Forsyth

Gaston

Gates

72
1
4

Guilford .

109

Halifax

Harnett _

Ired ell

150 75

16 5
40

9 i 19
2 ■

5 9^

Jackson*

Johnston

McDowell

Madison ._

Mecklenburg..

Mitchell

New Hanover

Nash

Orange..

Paquotank ... _

Pender*

Randolph

Robeson

4
H
48
11
2

59
45

1
51

Rockingham

Rowan

Rutherford

Sampson

Wake

Warren .

Watauga

20
35
125
3
20

Wayne

Wilkes*

Wilson

Yadkin

6
0.5

Total in forty-eight counties

1,168

848

2,011

8
039

* Estimated.

K". C. MEDICAL SOCIETY. 217

In compliance with the instructions of the board I have prepared a
new and up to date edition of Instructions for Quarantine Disinfec-
tion, and it will be mailed to all the physicians of the State as soon
as I can get a complete and accurate list of them. This work is now
in progress.

The chief and most important work of the year has been the re-
organization and refitting of the State Laboratory of Hygiene, which,
while a separate entity, is placed by the law under the control of the
State Board of Health. Upon the retirement of Dr. McCarthy we were
fortunate in securing as Director of the Laboratory a man well edu-
cated academically and well trained technically, an M.S. of our own
University and an M.D. of Johns Hopkins, with a biological laboratory
experience of nearly ten years. Dr. C. A. Shore, who, by the way, is a
citizen of this goodly town. We have been likewise no less fortunate
in securing as chemist Miss Daisy B. Allen, who, I am assured by
Dr. Herty, Professor of Chemistry at the University, has never been
excelled, if equaled, by any graduate of that department during his
incumbency. Thanks to the generosity of the Legislature we were
enabled to thoroughly refit the laboratory with the most approved
apparatus and first-class work can be expected.

Those who have read the Monthly Bulletin regularly will remember
that the last General Assembly authorized the preventive treatment
of hydrophobia by the director of the laboratory when the Board of
Health should think it wise to undertake it, provided the funds at
their disposal should justify it without interfering with the- regular
work. With the two thousand dollars annually appropriated by the
last Legislature, in addition to the tax on public water companies, I
believe this could now be done to the great relief of many of our poorer
citizens unable to afford the expensive treatment of the various Pasteur
institutes. This however, would necessitate the employment of a com-
petent assistant, as the director, even now, has all his time occupied
in the general work, but we can now afford it and we recommend it.
The report of the director of the laboratory accompanies this. As
the laboratory is intended for the benefit of the people, through the
medical profession, it is hoped that the physicians will freely avail
themselves of its help.

(See index for other proceedings, discussions etc., of "Conjoint Ses-
sion." ) Editor.

Report of the Obituary Committee North CaroHna
Medical Society, June 17, 1908

COMMITTEE:

CHARLES A. JULIAN, M.D., Thomasville.
BENJ. K. HAYS, M.D., Oxford.
ROBT. L. GIBBON, M.D., Charlotte.

IN MEMORIAM

PATRICK LIVIXGSTOX MURPHY.

JOSEPH GRAHAM.

THOMAS DEVEREAUX HAIGH.

LAWRENCE EDWARD HOLMES.

ROBERT H. HOLLIDAY.

J. F. BEALL.

J. D. McMILLAX.

ELIAS KERXER.

RAXDOLPH VAMPIL.

R. G. WASHBURX.

C. L. BRYAX.

M. W. HARPER.

S. B. KEXNEDY.

H. A. McSWAIX.

ROBERT ROBERSOX.

C. H. LEWIS.

J. J. ]\IANX.

JOHX D. SPICER.

JASPER LEE BEAM.

JAMES HERBERT REYXOLDS.

WILLIAM T. HOWARD.

W. R. CAPEHART.

'There is no death! An angel form

Walks o'er the earth with silent tread :

He bears our best beloved away,
And then we call them de;id.

Ah! ever near us, though unseen.
The dear immortal spirits tread;

For all the boundless universe
Is life! There is no death!"

Necrology.

PATRICK LIVINGSTON MURPHY: AN APPRECIATION.

BY GEORGE GILLETT THOMAS, M.D., WILMINGTON, N. C.

In all the history of this organization, made and nourished by the
thought and care of the medical men of our State, there has come into
its fold no better, purer, or more unselfish man than Patrick Livings-
ton Murphy. Born in North Carolina, reared among his people, proud
of his ancestry and its connection with the many changes that have
brought the State to its present high position, he inherited and worthily
cultivated the very best traits of character of those of his people whose
liA'es were spent in the interest of good citizenship. He was naturally
a man of retiring nature, and yet so thoroughly did he enter into the
intimate details of vi^hatever he felt was a part of his life's duty, that
when the occasion arose for him to begin the prosecution of schemes
for the betterment of conditions that appealed to his position in the life
of the State, he was ready to do his full part and to defend with intelli-
gence and zeal the policies and methods, which he adopted, or to which
he gave his influence. A marked characteristic of Dr. Murphy was
fixedness of purpose. He seemed never in haste to determine what
was right, or to find it necessary to alter the course of action which
he had adopted. This mental trait, shall we not say this great mental
development was the source of his eminent success, and should be the
reason why we, who join our sorrows in this memorial service, shall
consider his life among us with profit for its example, and be aroused
to a justifiable desire to emulate his great virtue. His whole life was
so full of the work of an honest man to whom God had given a great
mind, that it is a simple story, shortly told, to set out what he has
done. Only those who thoroughly master all the details of whatsoever
they undertake are simple in their methods, or direct in the prosecu-
tion of their schemes. These two elements of greatness were fully
combined in Dr. Murphy. No man in our memory has builded for
himself a memorial more lasting than he. To you all he was well
known as a Avise counselor, a man of excellent judgment, and a person
who was infrequently heard in the discussions of this Society, but
whenever the occasion arose for him to take part in the settling of
policies, or in discussing the merits of questions presented to this
body, he was accorded, as he deserved, a willing hearing, as he always
presented a persuasive argument; it was simple, it was clear, it was
founded upon good judgment, and it was convincing.

He entered upon his duties as Superintendent of the Western Hospital
for the Insane when the buildings were just finished, when, in fact,
they were only so far finished that he could enter them and begin to
organize the forces that were to make eventually this institution one

tn^ai/^c A Wni^nr.f-

If. C. MEDICAL SOCIETY. 221

of the models of its kind in all this broad land; when the land sur-
rounding the buildings was in its original wild and disordered shape,
and with all the evidences of the workman's labor still scattered over
the premises, and with hardly an api^roach to the grounds that was
worthy of the name of a road. Beginning thus, he labored with un-
changing policy to make his life's work a success, to show what was
possible for an honest man, pursuing honest labor and the highest
purposes, to accomplish. Almost a stranger in his new home, there
were few to whom he could appeal for advice, and he began at once to
rely upon himself more than he had ever done before in the determina-
tion of the many vexing questions that were presented to him from
the beginning up to the day his great life ended. Painstaking care
was the keystone of his success, and no detail in the workings of the
great hospital passed by him without his notice and his earnest con-
sideration. He early saw and determined the possibility of making
this hospital peculiarly a State institution in every sense, and to this
end his employees almost without exception were from the first and
throughout his life from the people of the State, in many instances
from the immediate neighborhood. These, enthused by his example
and led by his intelligent care, have done their work faithfully and
zealously, and are now as eager as the superintendent was to accomplish
for the State's wards, the unfortunate insane, all that can be done for
their comfort and cure, ilany of these, his original employees, were
among that household which followed his body to the grave, sorrowing
as those only sorrow who have lost a friend. It was his influence that
led them, and his mind that guided them. They were sure of his com-
mendation for duty well done, and equally sure of his disapproval of
duty neglected, as well as his sympathy when it was needed or deserved.
In my intercourse with him and thank God it was a long and loving
friendship, there was no evidence of wavering of purpose. With a
previous training of some length in other hospitals for the insane, he
came to his work with the confident belief that as insanity was a dis-
ease, it should be treated in such a way that the sufferers, the inmates
of his institution, would be placed upon a footing that would approach
the treatment of mentally normal human beings as near as possible.
This was intended to produce, and gradually it has produced in the
population of this hospital, a suggestion of relief. These stricken ones
in their narrow way began to feel shortly after their admission that
they were not pariahs, or people set apart from the whole world, but
sick people to Avhom gentleness acutely appealed. As rapidly as possi-
ble, in keeping with the teaching of the best alienists, he discarded
more and more all such bodily restraints as could be dispensed with.
This policy expanded each year, and until it has reached now a sur-
prising degree. To this he has added occupation, the combination of
the two serving to produce a healing diversion. It was a fortunate
combination of a man thoroughly fitted for his work, and the provision
of the work in such shape as to elicit his best talents.

222 FIFTY-FIFTH ANNUAL SESSION

But over it all, above the policies of the hospital, above the treat-
ment adopted, and tlie measures put into effect, changing only as
circumstances allowed or demanded, but always long the same general
line, there stood in its benign influence the commanding character and
personality of him whom we mourn. To him this institution was a part
of his personal self. He knew all of his patients, he knew their history
and many of their previous surroundings, and their bearing upon the
development of the terrible condition which had brought them under his
care. He accorded to each one just such attention as was needed
to lift as far as he could the depressing cloud that made life a misery.
His control was almost supreme in the wards, and its effect upon his
people was a most pleasing, yes, and inspiring spectacle. Added to
this he knew absolutely the whole value of the hospital in its material
part. He encompassed the entire domestic economy, which included
the health, food, water supply, the heating, the ventilation, the sanitary
condition, the preparation of the land and its productive farming the
choice and purchase of more property, the planning and building of
additions to the original houses, and the founding and successfully
operated colony situated well away from the main building, the adop-
tion of all mechanical economies for the betterment of the service,
and the more easy performance of the best work in all departments.
These and all these he knew, and it all made the western hospital
for the insane an institution as near complete as might be, and its
surroundings a feast for the eye and a place where rest and recupera-
tion seemed most possible, and yet with all this labor, he seemed never
hurried. He quietly began with a purpose, which he had carefully
worked out, and he followed it, changing only the details which would
more easily achieve his hoped-for results. Seeing the product of his
labor and realizing his honesty, his purity of life, his christian charac-
ter, he received the justified confidence of the people of the State,
and he died the servant of the State with the full knowledge that he
had done his duty, and that his work followed him in the appreciation
of his fellow citizens.

I feel that I do not go beyond my rights as his friend to say that
among the elements that went together to make his life a great one,
was the character and help which was always near at hand, in the
influence and strength of mind of his wife. In many ways she served
to secure for him the best results of his work. With all of his lovable
characteristics, his manliness, his intelligence, and his high purpose. Dr.
Murphy was not always a patient man, and who is? Recollect that he
was full of the rich blood of a belligerent ancestry, and naturally then
he chafed at times under the restraints that an all too improvident and
niggardly public policy placed upon him ; his temper, as far as I know,
never unjustly expended, was often sorely tried. His wrath was to
be feared when he was aroused, and he was outspoken in his defense
of right and in his denunciation of wrong, and persistent and clear
in his demands for such things as made for the betterment of the

]Sr. C. MEDICAL SOCIETY. 223

poor sufferers who came under hia care. In all of those trying times,
and necessarily there were many of them in the period of his service
to the State, there coud be no one nearer to him and there was no
better counselor than this good woman who was cheerfully, intelli-
gently, and persistently in all things his helpmeet.

One afternoon in the fall before his death, unannounced I went to
the hospital, and after some search I found our friend in the extreme
one of the buildings, superintending, with a show of his former energy
and intelligence, the installation of some new machinery, which was
to add to the economical and more perfect working of the institution.
I had from him the customary loving and old time welcome, and after
a few minutes, as he was unable to walk so far, he was rolled back
to his part of the institution in the center of the great buildings.
The time was late in the afternoon and the sun was rapidly approach-
ing the tops of the Blue Ridge. After a short stay in the house, with
much effort he walked with me out on the vast upper terrace near the
end of the great central building. There we stood in the soft glow
of the coming twilight, looking down through the trees toward the
town of Morganton. Our eyes ran delightedly through vistas made
by the happy location of the trees over green slopes and soft velvety
carpets of grass. Everywhere he saw the results of his work, and I
appreciated his wonderful taste. He had left on this great lawn the
best of the native trees, and had added to them only the choicest
varieties of exotics suited to the place and to his purpose of beautify-
ing the effect. Away to the South beyond the park confines, the prop-
erty ran down to a stream, which meandered through fertile fields,
here showing the work of the plowman in the upturned rich red soil,
and there the result in green hillsides and leafy and well laden fruit
trees stretching up to the top of a distant knoll. There was quiet
everywhere, and it told of the coming night. The only sounds to break
the stillness were the clink and rattle in the distance of the teams
returning from the work in the fields, and slowly gathering into the
barns. The air was still laden with the perfvimes of fresh cut grass
mingled with that of the late flowers. In front of us were the grassy
slopes covered with the shadows of the trees made by the last rays
of the sun. These slopes dropped in gentle grades into deeper hollows
down to the bottom of the hillside near the stream. But the day was
wearing out, and in the stillness and softened shades of the hour, he
looked midway from where we stood and the deep hollow in the hills,
and he directed my eye to a spot that seemed to both of us the most
enticing in all the grounds. His weakness was overcoming him, and
after gazing lovingly at all the beauty before him, his eyes rested
again on the one spoli that seemed to hold him longest, and then we
turned away and went slowly into the house, humoring, as was neces-
sary, his faltering steps. Night came on, and thi'ough its hours I
was impressed with the thought that he was contemplating his death,
and that he had chosen this place, which he had indicated, as the

224 FIFTY-FIFTH AXI^^UAL SESSI02J

one that he would select for his final rest. It was the place where
they laid him. His friends in the village, mourning as men mourn the
loss of a man whom they had learned to love and trust with implicit
confidence, by common consent asked that he be buried in the grounds,
and when those to whom this request was carried, consented, his fel-
low townsmen, too, chose the place that he had for his last home.

Surely as one looks over this great man's life and his works, realiz-
ing the firm sway of a superintendent that was always kind and
gentle in its unfailing kindness and justice, the loving forbearance to
those who deserved it, and the healing property of punishment given
to those who needed it, always tempered with mercy, all that his great
mind could do to affect the spiritual and material atmosphere of this
institution, and then upon the grounds bearing the heavy burden of
the crops, the rolling hillsides near at hand, and recalled those in the
distance beyond the range of sight, place upon place, all carrying the
impress of his energy and care, the verdure of the grass and the leafy
trees, surely as one felt the inspiration of it all, the man and his
works and their results, and the restorative rest that followed it,
there could be no other legend inscribed on his monument more in-
spiring to the visitor as he stood by his last resting place and looked
over the scene of his days of labor, than these simple words: "Hie
fecit." He rests in the midst of his work he did so well, and respect
and admiration for his life and character, and loving affection for his
kindness and gentleness, make living memorials to his worth.

God grant that we may in our way, emulating his life and its
example, so use the talents that have been given us that we may, like
him, enter into the rest that has been promised to follow a well ordered
and useful life.

PATRICK LIVINGSTON MURPHY, M.D.

BY RICHARD H. LEWIS, M.D., RALEIGH, N. C.

The subject of this memorial tribute was born in Sampson County
near Clinton, October 23, 1848, and died in Morganton, September 11,
1907. His father the late Patrick Murphy of Scotch descent, was a
successful lawyer and man of business, his mother, Eliza A. Faison,
was a member of the prominent and influential family of that name
residing in Sampson and Duplin counties. He was delicate as a child,
but thanks to the life on a plantation with its mingled work and play,
where his boyhood was spent, he grew up to be a strong and vigorous
man.

His academic education was obtained in the schools of the neighbor-
hood, at the famous Bingham School and at that of Col. Tew in Hills-
boro. In 1869 he entered upon his medical studies at the University
of Virginia and there began between himself and the writer a warm
and devoted friendship that lasted unbroken and untarnished to the
end. After one year there he went to the University of Maryland and
was graduated M.D. March 1, 1871.

X. C. MEDICAL SOCIETY. 225

He began the practice of his profession in his native county, but
soon moved to Wilmington, where, in association with Dr. Wm. J.
Love, he continued his work as a general practitioner for several years.

Upon his unfortunate marriage in October, 1878, to Miss Bettie Wad-
dell Bumgardner of August County, Virginia, who proved in every sense
of the word a true helpmeet, he removed to that State. Shortly there-
after he was elected assistant physician in the Asylum for the Insane
at Staunton and served in that capacity three years, with such ability,
as the sequel showed, as to bring about his election as Superintendent
of the Morganton Asylum.

When he wrote me that he was a candidate for that position I set
about promoting his election with all my heart. In addition to letters
to other members of the Board of Directors I had a personal interview
with the late Dr. Fuller, who for many years was first assistant in the
Raleigh Asylum, and who, owing to his experience and to his own
personality, was a most influential, member of the Board of Directors
of the new institution. I was fortun*e enough so to impress and
interest him in Dr. Murphy that he wrote a personal letter to Dr.
Fauntleroy, the superintendent of the Staunton Asylum, asking for a
candid opinion as to his fitness for the place. After a full discussion
by the Board of Directors of the merits and qualifications of the
several candidates, among whom were some of the leading physicians
of the State, Dr. Fuller read Dr. Fauntleroy's letter and that letter,
together with his own advocacy based upon it, I was told, settled
the question of the election of Dr. Murphy as the first Superintendent
of the State Hospital at Morganton. The fact that I was thus, in
part, instrvunental in bringing about not only the professional ad-
vancement of my own dear friend, but, throvigh the noble work he
then began, in conferring an inestimable boon upon the unfortunate
insane of our State, will ever abide with me as one of the most cher-
ished memories of my life.

When he assumed charge of the asylum it consisted of a central or
administration building and 'one wing, with a capacity of one hundred
and fifty patients. At the time of his death the main building, with a
base line of an even mile, and numerous other buildings, accomodating
all together over one thousand one hundred patients, represented the
plant that had grown up under his administration ; a truly magnificent
institution in structure, arrangement and appointments. To him, more
than any other single Influence, is due this marvelous development in
so short a time, less than twenty-four years. While the general control
lay in the Board of Directors and the means of growth in the Legis-
lature, he so impressed them with his honesty as a man and his
ability as a manager and so inspired them with his own enthusiasm
in the noble work of ministering to the unfortunate insane, that they
were led to do great things. Every one who has visited the hospital,
with Its mass of great buildings in grounds of unusual beauty and

226 FIFTY-FIFTH AN^^LTAL SESSION

who has observed its workings has been impressed with the fact tliat
it was indeed a grand institution, guided and controlled by a master
hand. I never went there but I was reminded of the great Coiliss
engine at the Centennial Exposition, so big, so powerful, so compli-
cated, and yet so smooth and noiseless in its running. It was the man
at the throttle, so thoroughly acquainted with every detail of the great
mechanism and so sure of his knowledge.

Dr. Murphy was a great administrator of rare executive ability.
In addition to a vigorous and well-informed intellect he possessed the
gift of common sense, a real talent for mechanics and a keen power
of observation. Nothing escaped his watchful eye. No cog slipped
in the great machine that he did not note and correct it. These quali-
ties combined with a strong will, the courage of his convictions and a
conscientious and unfaltering sense of duty and responsibility made
him the great executive officer that he was. To repeat the words of
one of our leading business men, he was one of the great men of North
Carolina.

Our friend was a t.ypical Scotch American and his faults were the
faults really of his virtues. He was essentially a strong man in body,
mind and character; honest, frank and straightforward with a hatred for
shams of all kinds. While his character was, perhaps more notable
for the fortiter in re than the suaviter in modo, he had a heart of gold.
He was a devoted and loving husband and father, a faithful, affectionate
friend, a loyal and patriotic citizen. One of the most beautiful things
in his character was his tender and unfailing interest in the welfare
of his patients, which was ever uppermost in his mind. An intelli-
gent inmate of the institution told me that in the several years of his
residence he had, with one single exception, never heard anything but
expressions of trust and affection for Dr. Murphy from the patients.
What a tribute! The officers and employees of the institution all ad-
mired and loved him likewise.

In his long and painful illness from disease of the pancreas, lasting
after its distinct development just a year, -although fully aware of the
final result, he never quailed but looked death in the face with calm-
ness and confidence. Beyond the separation from his family and friends
his chief regret was that his work was ended, a work that was truly
his very life. It was indeed his ruling passion, literally strong in death,
for his last indistinct words related to it.

He was a reader of good books and his mind was well stored with
the best in science, history and literature. One of his greatest blessings
and most attractive qualities was a keen sense of humor. His hearty
and contagious laugh was a joy. He was an interesting and delight-
ful companion.

He was an excellent general physician and in his specialty ranked
among the first alienists in the country. He was no mere imitator of
others, but initiated and carried to a successful conclusion improve-
ments in the treatment of the insane that won admiration from his

N. C. MEDICAL SOCIETY. 227

associates. As a m«mber of our own Society his worth was recognized
in his election as a member of the Board of Examiners and as Presi-
dent, in which positions he served with honor and credit.

He had expressed a wish that he might be buried in the hospital
grounds, and in deference to this and to an earnest petition from the
citizens of Morganton it was agreed to by his family and the Board
of Directors, and so, under the velvet turf of the sloping lawn, almost
within the shadow of the great buildings and in full view of the
beautiful mountains he loved so well, he was laid away to await the
resurrection morn. After twenty-three years of arduous, devoted,
unselfish and rarely successful work spent in ministering to the most
pitiful of all God's afflicted creatures, winning thereby the gratitude
of his State and honor for himself, he rests from his labors and his
works do follow him.

LIFE AND WORK OF PATRICK LIVINGSTON MURPHY.

BY G. M. COOPER, M.D., CLINTON, K. C.

The history of a country is the record of the achievements of its
great men. The modern history of PYance is the history of Napoleon
Bonaparte, Victor Hugo and Louis Pasteur. The Crown Encyclopedia
says that " for more than 20 years the life of Oliver Cromwell was the
history of England"' and in no less sense is that true of Shakespeare
and Edward Jenner. The German historian of the future will place
the name of Von Bering high on the roll of Germany's great men. Any
schoolboy is familiar with the record of Daniel Boone's part in Kentucky
history, and Kentucky historians of to-day are beginning to take note
of its other great pioneer. Dr. Ephraim McDowell, whose courage was
greater than any man who ever shouldered a gun and faced an Indian's
arrow.

And so when the North Carolina history for the past quarter of
a century is written, along with the name of Vance should be that of
Dr. Patrick Livingston Murphy. For what Vance was to the political
life of the State, Dr. Murphy was in a fuller measure to the medical
profession.

As a native of Sampson County and in behalf of the Sampson County
Medical Society, in a nonofficial capacity, I wish to offer a brief tribute
to the memory of her great son. And in passing, I Tiope, Mr. Presi-
dent, you will pardon me if I call attention to the fact that it hag
been only a few years since the death of Dr. Kirby, for a long time
Superintendent of the Eastern Hospital at Raleigh, another of
Sampson's most distinguished sons, and also I would like for you to
recall the fact that the first recorded operation for ovariotomy ever
done in the State of North Carolina was performed by another of
Sampson's eminent sons. Dr. Almond Holmes, of Clinton, one of the
most refined and courteous gentlemen I have ever known. I mention

228 FIFTY-FIFTH AZ^^NUAL SESSION"

these names only to illustrate the type of gentlemen of which Dr.
Murphy was an illustrious example.

Patrick Livingston Murphy was born in Sampson County on the
23d day of October, 1848. His first North Carolina ancestor was
Patrick Murphy, who came from Scotland direct to this State. His
mother before marriage was Miss Eliza Faison, a member of one of
the largest and most influential families of Sampson County. His
boyhood was spent on his father's farm in Sampson County while not
in school. He was prepared for college at the old Male Academy at
Clinton and at Bingham's. After the close of the war he was j^ent to
the University of Virginia and afterward graduated in medicine at the
University of Maryland in 1871.

He returned to Sampson and practiced medicine for a short while
and then located at Wilmington, where he practiced in partnership
with Dr. Love for a few years. In October, 1878, Dr. Murphy was
married to Miss Bettie Waddell Bumgardner of Virginia, who survives
her husband.

In March, 1879 Dr. Murphy was elected assistant physician in the
Western Hospital of Staunton, Virginia, which jjosition he held until
he resigned in the spring of 1882. In December, 1882, Dr. Murphy
was elected Superintendent of the Western North Carolina Asylum as
its first superintendent, which position he so ably filled for a quarter
of a century. Just here I can do no better than to quote a paragraph
from the Raleigh Christian Advocate of February 6, 1889, written about
seven years after the opening of the hospital for patients, and whose
editor, Rev. Dr. Black, was his personal friend. "His credentials and
all the reports concerning him were such as to have pointed liim out
clearly to the directors as the man for the place, and though there was
no lack of able and accomplished physicians applying, he secured the
honor easily. His management and the results of his Avork have
justified the board entirely. His genius for organization manifested
itself at once, so that the asylum opened on a basis, to which very few
men could have brought it to under all the adverse circumstances of
the time. His management since has been in all respects most ad-
mirable. He was governed, as the manager of all such institutions
must, with great firmness but without harshness. He has great per-
sonal popularity with the subordinate ofiicers and the employees of
the asylum, while the patients are devoted to him, 'made so by his
gentleness toward them and his manifest interest in them individually
and in their welfare. In proof of his control over them it is only
necessary to say that no form of physical restraint has been used in
the Western Insane Asylum for three years. To those who associate
clanking chains and other forms of personal ill-usage with insane
asylums, this statement will doubtless be a revelation, but it is stated
as a fact that the insane at Morganton are controlled by moral suasion
united with medical treatment."

A magnificient tribute from one great man to another ; and yet how

K. C. MEDICAL SOCIETY. 229

much, how infinitely greater are the achievements of the nearly twenty
years since Dr. Black wrote the above sketch. Add to his record in the
asjdum management his official record as a member of the Board of
Medical Examiners of Xorth Carolina; President of this Society: an
officer in the American Psychological Association, and as a member of
the Board of Directors of the North Carolina School for the Deaf and
Dumb, and other positions of trust and honor in church and state,
these have made his services to the people of his State of untold
value, and the people of this great State have not fallen short in their
estimate of the man.

Descended from a long line of Scotch ancestry, he was a patrician
of that old southern school as distinguished in its days as the Romans
of past historj'. And yet, as the editor of the Charlotte Observer
truly said in writing of his death: "To him all men and women were
as one. There were none too humble to enlist his sympathy or chal-
lenge his best skill. * * * It is his glory that in his exalted
professional life he knew no distinction between classes."

In the life-work of Dr. Murphy there is so much to commend, so
many things which stand out to distinguish him as the foremost alienist
of the South, that it is not necessary for me to call attenion to any
particular phase of his work. Yet I hardly think a sketch of
this nature complete without dwelling on his splendid achievements in
the "Colony Treatment of the Insane." About five years ago Dr.
Murphy had prepared ready for occupancy a number of colony build-
ings made after the order of the farm houses in that section of the
State and each house to be occupied by a limited number of the insane
patients of the Morganton Hospital. These colonies were a modifica-
tion of the original German conception. The all-important idea in
the establishment of each was to impress upon each patient, if possible,
the fact that he j^et had a home and that, though in a small capacity,
he was still a factor in the affairs of his community, he still had some-
thing to do. How well he succeeded in this plan of treatment, is a
matter of common knowledge to every medical man in the State to-
day.

In describing the beginning of his experiment in a paper read
before the Society at Charlotte two years ago, Dr. Murphy said, after
telling of the nucleus of organization by sending a few quiet, industrious
men to the first colony: "that a further experiment was made by send-
ing those who seemed incurably demented, incapable by reason of their
Aveakened minds, of doing any kind of work — most of whom had been
residents of the hospital for years and years, in whom the last vestige
of hope for any improvement had long vanished. Strange as it may
seem to you, as it did to us, acquainted with these men and their
disease, they immediately went to work and are to-day profitably em-
ployed. They have gained in health and self-confidence; they are
happier because they feel there is yet something in life for them."

I believe in all sincerity that history will accord to Dr. Murphy his

230 FIFTY-FIFTH AXNUAL SESSIONS"

true place as one of the greatest alienists of his time. Indeed, he was
one of the men who lived far ahead of his fellows. And the fullest
measure of his success was due to his one great guiding principle of
always exhausting every means at his command in the endeavor to suit
the treatment of each patient to that especial individual, and not to
treat his patients in a routine manner. That I may emphasize more
distinctly this superior quality in Dr. Murphy's character I hope it
may not be considered amiss if I call attention to a book now before
the public entitled "A Mind That Found Itself," and of which the
Journal of the American Medical Association says editorially, "It
calculated to stir the public mind to its depths." To quote further,
"It depicts with vivid lights and shadows a malady whose sufferings
and sorrows are the deepest that life can bring."

Briefly, it is the story of an educated young man, whose health
is impaired and whose mind is shattered, placed in an asylum and whose
condition is only made worse by the endeavor to administer routine
treatment and to tit him into a class. He recovers and writes of his
experiences. Whatever criticism this work may incite against the
various hospitals of the country, not one line can be directed against
the Morganton Hospital, because, as noted above. Dr. Murphy lived
ahead of his time and his work was the building of a master hand.

It can never be said of Dr. Murphy, as we so often read in the daily
papers, to the everlasting shame of the profession, pay your expert
and get your testimony. He was a man of rugged honesty. He lived
above the miasma of partisan politics and no politician ever dared lay
his hand on the management of the great institution over which he so
ably presided. And while the closing years of his life were to some
extent embittered by the wanton attacks of a few man of small caliber,
what man among us, even at the foot of the ladder to success, has not
felt the sting of petty jealousy and the strife which is so often en-
gendered by prejudice. And yet all such accusations only served to
make his great worth to the State more appreciated and his star
never shone with greater brilliancy than on the day of his death.

There are hundreds of homes in North Carolina to-day that have
been made happy by the return of a loved one from his hospital with
mind restored and life again made attractive.

He had the ability to invade that vast twilight-land of melancholia
and instituting proper treatment to those with any rejnnant of mind
left, thereby lifting the shadows and saving many an unfortunate from
a condition worse than death.

According to Dr. Murphy's own statement at Charlotte two years
ago, there were then twenty-five hiuidred insane persons in North
Carolina who could not be taken in the hospitals on accoimt of lack
of accomodation. There can not be less than that number to-day, not-
withstanding the increased appropriation made by the last Legislature.
And as long as such a state of affairs exists, it behooves us as an

N. C. MEDICAL SOCIETY. 231

organization to throw the weight of our influence upon every Legisla-
ture and every would-be legislator, until every one of these poor un-
fortunate creatures have an opportunity to regain that which they have
lost without which life is a curse.

When success has crowned our efforts we will have the satisfaction
of a duty well done; and in so doing we will erect to the memory of
Patrick Livingston Murphy, a monument more enduring than brass
and more lasting than marble.

JOSEPH GRAHAM.

BY H. T. BAHXSOX, M.D., WINSTON-SALEM, N. C.

Was born April 30th, 1837, in New Bern, N. C. He was the eldest
of ten children, six of whom are still living. His father, William
Alexander Graham, was a most honored son of North Carolina — legisla-
tor, twice Governor of the State, Senator of the United States and
Confederate States, Secretary of the U. S. Navy, and projector of the
famous expedition which opened the ports of Japan to the commerce
of the world. His mother was the daughter of John Washington, of
New Bern, N. C, one of the foremost men of his time, and a relative
of General George Washington.

His childhood was spent in the ancestral home of Hillsboro, N. C.
In 1850, at the age of thirteen, he accompanied his parents to Washing-
ton, D. C. Three years later, he entered the University of North
Carolina, from which he graduated with honor in 18.57. He then be-
gan the study of medicine under the famous Dr. Edmund Strudwick
in Hillsboro, and took his degree of M.D. from Jefferson Medical Col-
lege, Philadelphia, Pa., in the spring of 1859, spending the summer
and fall of this year in the hospitals of Philadelphia.

On October 26th, 1859, he was united in marriage to Miss Elizabeth
Hill, daughter of the late Thomas Blount Hill, one of the most cul-
tured gentlemen of his day. Tlie love and sympathy of this beautiful
and refined woman made for him a home life that was ideally happy.
Of the five children born to this imion, only two survive to comfort the
bereaved wife and mother.

After his marriage. Dr. Graham settled in Charlotte for the practice
of his profession. Although, like his father and family, opposed to
secession, he promptly responded when the State called her sons to
arms, and with his four brothers went to the front. He raised a com-
pany of artillery, and was elected lieutenant. Upon the resignation
of Captain Brem, he succeeded to the command, and the company was
known as "Graham's Battery." The men were enlisted for the war,
and not for twelve months as were most of the troops. The battery
was attached to Branch's Brigade until after the battle of New Bern
in March, 1862, when it was transferred to Daniel's Brigade. This bat-
tery fired the first shot of the cannonading, which preceded the famous
charge of the third day at Gettysburg. Although Captain Graham

232 FIFTY-FIFTH AXNUAL SESSION

participated in most of the bloody battles in Virginia, he was never
wounded. In 1864, Captain Graham resigned his command in the artil-
lery and was commissioned Major and Surgeon of the 67th N. C.
Regiment, in which capacity he served until the surrender.

Returning home, like all other gray-clad veterans to begin life anew,
Dr Graham located In Gaston County, and there practiced his profes-
sion until the spring of 1869, when he returned to Charlotte, which
was destined to be the stage of his great and honorable career. The
following year, 1870, he formed a copartnership with Dr. Johnston B.
Jones, which was broken only by the death of Dr. Jones in 1889.
The I'ate Dr. Simmons B. Jones succeeded his father in the partner-
ship. Later, Dr. William A. Graham, an only son, on wliom his father's
mantle has fallen, became his partner, and by his valuable assistance
and skill prolonged his father's life and relieved him of a portion of
his work.

It was my good fortune to be counted among Dr. Graham's intimate
friends, and at our Society and other meetings we were roommates
for many years. Through this close and confidential association, I
learned to appreciate the awful burden of distress and suflfering he
endured uncomplainingly, during nearly all the years of his active
professional life. About 1870 he began to experience difficulty in
swallowing food. It failed often to reach the stomach, and after a short
time would be regurgitated. The symptoms were those of a structure
of the sesophages, but neither during life nor after death was there
a stenosis or pouching to be found. In vain he consulted the Ijest
clinicians again and again. Not one could give him relief, but all
advised against any operative interference. At first the trouble oc-
curred only occasionally, but gradually became more or less constant.
Of late years, I have seen him lose meal after meal, while suffering
the most distressing pangs of unsatisfied hunger, and for days before
his death neither food nor drink could enter his stomach.

Under such a burden almost any other man would have sunk into
helpless invalidism, but Dr. Graham's self-forgetfulness and devotion
to his profession easily overcame this apparently insurmountable hin-
drance to his usefulness. To him, as to the great leader whom both
of us loved and followed in war, the greatest word in the language
was "duty," and he unflinchingly sacrificed comfort and home ties
and life itself in its performance. To the very last he was always
ready to respond to the call of the sick and suflfering, and he truly lived
for others.

In early life Dr. Graham connected himself with the Baptish Church,
that being the faith of his mother, but his religion rose aliove any
creed. It was the religion inspired by love of God and love foi- man-
kind. He was a diligent student of the Bible, and few have lived
closer to the spirit of its teachings. Throughout his life he was a
man of prayer, and the words which fell from his lips during his
last agonizing days voiced his faith and love and "blessed assurance."

X. C. MEDICAL SOCIETY. 233

Surrounded by his family he "fell on sleep"' xlugust 13th, 1907, at
the ripe age of seventy years and four months.

For nearly forty years Dr. Graham was the leading physician in
his section. His broad intellectuality, his sound judgment, his keen
discernment, his knowledge of the subject, his quick and correct diag-
nosis, his boundless sympathy, his devotion to his work, his great skill,
his splendid nerve and prompt action — all inspired a confidence and
love that gave him a practice which for extent and usefulness has
seldom been equaled in this State. No doctor was ever more idolized
by his patients, or more respected by his colleagues. Of distinguished
presence and charming personality, he commanded the esteem of all
with whom he came in contact. He was a born leader, but without
the selfish ambition of the politician and demagogue. The offices he
filled, whether civic or professional, came to him unsought, and solely
in recognition of his merit and fitness. The Medical Society of North
Carolina honored itself in electing him to its highest offices, in ac-
knowledgment of his eminent skill and faithful, constant efforts to
alleviate human suffering. He served on the Board of Medical Ex-
aminers from 1878 until 1884, and in 1886 was elected President of
the Society.

In his pure life and spotless integrity Dr. Graham kept the faith
of his fathers. His innate refinement, his cleanness of thought and
word and life, were his birthright. His character was founded and
built on the white stones of honor, truth, justice, love. Although
reticent by nature, he was candid and fearless in expressing his
opinions when asked for them. His temper was even, calm and well-
balanced. He was gentle, kind, charitable, tender-hearted as a woman,
generous and magnanimous. In his big heart there was no room for
enmity or jealousy.

The intrepid courage of his early manhood was eclipsed by the un-
conscious heroism of his later years. Fully aware of the incurable
character of his disease, and unmindful of his own suffering, he labored
unremittingly to bring hope and cheer and sunshine into the darkened
lives and homes of others.

We who have known him can not but be the better for the knowing.
Through knowing him, each of us is better fitted for life's duties.
We can conquer cowardice more easily, meet our temptations more
valiantly and more surely keep from the sin of skirking. His life
was a blessing, and his memory is a priceless heritage to his family,
to the State and to our profession.

Dr. JOSEPH GRAHAM.
The following is copied from The Charlotte Oiscrver:
Dr. Joseph Graham, the oldest and most eminent of Charlotte's physi-
cians, died this morning at 2 o'clock at the residence of his son, Dr.
William A. Graham, on West Seventh street.

The passing of this good man and great physician is an irreparable

234 riFTY-i<^irTH annual session

loss to the State, whose history is inseparable from that of the Graham
family and of the medical world, which he so singularly adorned.

For daj^s this people have watched for tidings from his sick-room
that would give some hope that his illness was not unto death, but
the news ever presaged the inevitable.

Early in the summer Dr. Graham went to Chapel Hill to attend a
reunion of his class. The surviving members are: Hon. A. C. Avery,
Major Robert Bingham, Hon. B. F. Grady, Major John W. Graham,
Dr. John E. Logan, Col. John S. Kenan, Hon. B. F. Whitefield. From
Chapel Hill Dr. Graham went to Brooklyn to see his daughter, Mrs.
Geo. Fitzsimmons, and grandchildren whom he had always loved with
a father's love, especiallj' his grandson and namesake, Joseph Graham
Fitzsimmons. His wife accompanied him on his trip. The doctor
was feeble when he left here, but he hoped to gain strength in the
cooler atmosphere of the north. Instead of improving he became worse
and decided to come home. Mr. Fitzsimmons accompanied him and
Mrs. Graham. He was very ill when he reached here. His son. Dr.
W. A. Graham, realized this. He and his wife — to whom Dr. Graham
was devotedly attached — nursed him day and night with the assistance
of Dr. Geo. Graham, Mrs. Fitzsimmons, Mr. Joseph MacLean, his son-
in-law, whom he loved like a son, between the two there ever existing
the relation of father and son.

Dr. Graham, with his unerring skill, knew his condition perfectly.
He handled his own case, directing up to his last moment of con-
sciousness, "Dr. Will" and Dr. George Graham as to the treatment.
Saturday he said to "Dr. Will:'' "Son, give me my glasses,'' and after
they were adjusted he looked at his hands very closely and said: "I
won't live but a few days." He had not retained any nourishment since
his return home.

Since 1870, and possibly before, Dr. Graham had had some seriovis
affection that caused him to choke often when eating. The trouble
was not in the throat, but very much lower down — about halfway
between the throat and stomach. He consulted Dr. Janeway and all
the other famous specialists of that day as to the advisability of having
an operation. None could diagnose the case, but all advised against
the knife, so Dr. Graham returned home to begin a battle with the
physical "thorn in the flesh"' that baffled not only his skill, but that
of the foremost New York physicians, not only of the 70's, but of each
succeeding decade. And such a fight he made! No one but himself
and his God knew how much he suffered, for, brave spirit, brave
soldier that he was, he bore his cross without a murmur; not even to
his loved wife and children did he complain, but his suffering, especially
in the latter years of his life, could be read in his face.

This trouble caused his death.

Since the day of his return no food, no water, has passed beyond
the obstruction. A man of less vitality, less combativeness, less nerve,
would have suceombed earlier. Dr. Graham had fought disease for
others for nearly fifty years. It Avas one of his characteristics that
he never gave up while there was breath in the body.

X. C. MEDICAL SOCIETY. 235

His physician instinct — this characteristic marked his last con-
scious moment. Up to the very last he advised his son and brother
what to do for him; what to give him.

Throughout his illness, as throughout his long and useful life, he
thought of others before himself.

He said to his son and daughter-in-law, who had nursed him so con-
stantly: "I am giving you so much trouble."

Mrs. Graham, his devoted wife, has been in feeble health for some
years and was not permitted to share the anxious vigil.

Since the first news of the Doctor's illness there has been daily, and
up to a late hour nightly, a constant stream of people calling at the
home to inquire of him. In each voice there has been a tremor; in
each eye, a tear. "For a half century there has been no doctor here
like him," said a friend yesterday. "Xor will there be for another half
century," replied another.

His death is a personal loss, a heart bereavement to more people
than any death that has ever occurred in Charlotte. Only that of
Rev. Dr. Preston was comparable to it.

Dr. Graham's life, not only his skill, was given unreservedly to his
patients. He was friend and adviser, as well as doctor.

His brothers. Judge Augustus Graham and Capt. John Graham, and
his only sist«r, Mrs. Susan Graham Clark, wife of Judge Walter Clark,
and her daughter arrived several days ago. Capt. James Graham, of
Washington, came this morning. Mrs. Joseph Webb and Miss Rebecca
Hill, sisters of Mrs. Graham arrived last week. From far and near
came devoted ones to offer themselves for any service they could render,
but there was none.

Dr. Stoke*, of Salisbury, spent Sunday at his bedside. Nothing could
be done — nothing but to stand by and see this great physician drink
of the cup that was not to pass.

Surrounded by this wealth of love, his great unafraid spirit passed.
It will ever be embalmed in the love and tears of a people to whom
he gave himself, day and night, in cheerful service for fifty years.

BIOGRAPHICAL.

Joseph Graham was a son of that distinguished son of Xorth Caro-
lina, William Alexander Graham — legislator, United States Senator,
twice Governer of the State, Secretary of the Navy, projector of the
famous Japan expedition, gentleman and scholar. His mother was
Susannah Sarah, daughter of John Washington, of New Bern, X. C,
one of the foremost men of his time and of kinship with General
George Washington.

Joseph Graham was the eldest of ten children: Joseph, John Wash-
ington, William Alexander, James Augustus, Robert Davidson, George
Washington, Augustus Washington, Susan Washington, Alfred Oeta-
vius, Eugene Berrien. The two latter died when quite young. Of the
others all survive but Dr. Graham and Capt. Robert Graham.

Joseph Graham was named for his distinguished grandfather, Major

236 FIFTY-EIFTH A^^:S^UAL SESSION

General Joseph Graham of revolutionary fame, was born in Xew Bern,
N. C, April 13, 1837. His childhood and boyhood passed with his
parents in their ancestral home at Hillsboro. His first school days
were spent at the Caldwell Institute in Hillsboro. When Joseph was
thirteen years of age his parents moved to Washington City, Governor
Graham having accepted a position in President Fillmore's cabinet
(1850). Governor Graham and President Filmore were considered the
handsomest men in Washington.

For the two years in which his father remained in office .Joseph was
placed in the Abbott Classical and Mathematical Academy at George-
town. In 1853 he entered the University of North Carolina, from which
he graduated with honors in 1857. He then began the study of medicine
under the famous Dr. Edmund Strudwick at Hillsboro. In the fall
of 1857 he entered Jeflferson Medical College in Philadelphia, from
which he graduated in the spring of 1859. The following summer and
fall were spent in the hospitals of Philadelphia.

Before leaving his native State the thread of romance — that "senti-
ment" which Rev. Dr. Kincaid of the First Presbyterian Church re-
cently, so beautifully described as the sweetest and purest part of
mans nature — was in the spinning. It drew the brilliant young doctor
back to the little town of Hillsboro and there, on October 26, 1859,
just a year after he had reached his majority, he was united in marriage
to the woman of his choice, Miss Elizabeth Hill, eldest daughter of
the late Thomas Blount Hill, of distinguished North Carolina ancestry,
and one of the most cultured and polished gentlemen of his day. This
union with this beautiful and high-born woman — his peer in birth and
refinement — was ideally happy. Throughout the 48 years of their
wedded life there was perfect love and sympathy and a home life that
was beautiful. Five children were born unto them: Elizabeth (the
late Mrs. Joseph MacLean) ; Joseph, Jr., died 1866, aged 7 years; Wil-
liam A. Graham (for many years one of Charlotte's leading physicians) ;
Riddie (Mrs. Geo. Fitsimmons), and Thos. Hill, who died at the age of
three years.

Dr. Graham came to Charlotte in 1859, came to the town that his
distinguished ancestors had made famous in revolutionary annals by
their bravery, and began the career which has made him so famous
throughout this and other States as a physician. His practice was inter-
rupted by the war. The State passed the ordinance of secession May,
1861. Governor Graham, then living, was ardently opposed to the
measure, but when it carried, like General Lee, he stood by and for his
State, serving all through the war as Senator in the second Confed-
erate Congress and giving to the service of the Confederacy his five
sons, all who were of military age.

Dr. Graham's character and all that he was to his country, his town
and his profession must be considered from four points: As soldier,
physician, citizen, man.

X. C. MEDICAL, SOCIETY. 237

AS SOLDIER.

When the war call went forth this man, his Scotch-Irish spirit fired
by the revolutionary blood within his veins, went to the front. He
raised a company of artillery, known as Brem's Battery (named for
the late Col. Thos. H. Brem), but afterward called Graham's North
Carolina Battery. Dr. Graham began service as second lieutenant.
Upon the resignation of Capt. Brem, he was promoted to the captaincy.

Dr. Graham's command was known as Battery C, Tenth North Caro-
lina Regiment, and enlisted for the war, not for twelve months, as most
of the troops did. The first officers were Thomas H. Brem, of Charlotte,
Captain; Samuel J. Lowry, First Lieutenant; Dr. Joseph Graham,
Second Lieutenant; A. B. Williams, Junior Second Lieutenant; J.
Springs Davidson, Orderly Sergeant. Lieutenant Williams succeeded
Captain Graham as captain of the battery till the end of the war. He
died at Fayetteville during the past year.

The battery was first attached to Branch's Brigade and served with
it until after the battle of New Bern in March, 1862. It was then trans-
ferred to Daniel's Brigade and took part in the battle of Malvern Hill.
It remained with Daniel's Brigade until the batteries Avere formed into
battalions and was then assigned to Poague's battalion, army of North-
ern Virginia.

The battery participated in the battle of Gettysburg and the sub-
sequent campaigns with this command. It was the battery that fired
the first shot in the connonade that preceded the charge of Pickett
and Pettigrew on the third day of the Gettysburg fight. On the same
day Maj. W. A. Graham, who was with Stuart in the cavalry, was
wounded.

In the campaign against New Bern and Washington, N. C, in Feb-
ruary, 1863, Captain Graham served as chief of artillery upon the staff
of Maj. Gen. D. H. Hill and directed the operations of that arm of
the service.

The battery also took part in the Mine Run campaign and in the
shelling of McClellan's fleet on the James River with 80 guns in the
vain hope of sinking some of his ships. At the second fight at Bristow
Station Dr. Graham's clothes were rent by a number of bullets.

In 1864 Dr. Graham was appointed a surgeon in the State service
and assigned to the Sixty-seventh North Carolina Regiment, Col. J. N.
Whitford, and remained here until the surrender. If he could have had
the promotion which he deserved for conspicious gallantry in the artil-
lery service he would have remained with it. By every token he
should have been promoted to major, for which position he was
recommended by the Adjutant-General of the State, after his long service
with Battery C, but it was keenly felt by most of the North Carolina
officers that Virginians were given the preference in the promotions,
and as he intended to make the practice of medicine his life-work, Dr.
Graham secured the appointment as surgeon.

238 riFTY-riFTH aivnual session

Well indeed may the soldier's wreath of honor lie on his casket
to-day. Because of soldiers of such spirit and caliber as Joseph Gra-
ham, the Confederacy's fight could be "unparalleled in the history of
nations."

PIIYSICIAX.

After Lee and Grant met at Appomattox, one to tender, the other
to accept the sword. Dr. Graham, like all other gray-clad heroes, re-
turned home to begin life anew. He decided to locate in Gaston Countj',
so moved his family there and practiced there until the spring of
1869, when he returned to Charlotte, destined to be the scene of his
great life-work, where he was to carve his name highest up in the
Physicians' Hall of Fame.

Dr. Graham brought to his work a mind prepared by study, a heart
governed by love, a hand trained by experience. His fame soon be-
came noised abroad. The great Dr. Marion Sims of iSTew York offered
him a partnership, but Dr. Graham preferred to remain in Charlotte.
Had he gone to New York fame would have built him a monument in
Bryant Park as it has Dr. Sims, for Dr. Graham's genius was of the
same order and kind as the great Southerner whom the State and city
of New York has honored in bronze.

Dr. Graham was the leading power of the medical world of this part
of the State throughout the 48 years of his practice. His intellectu-
ality, his force, his judgment, his prompt action, his keen discernment,
his knowledge of his subject, his ready and correct diagnosis, his
splendid nerve, his devotion to his work, his boundless sympathy, his
great skill, all inspired a confidence and love that gave him a practice
that, for size and influence, has seldom been equaled and never ex-
ceeded by any physician of the State. His patients were his friends,
his devoted loyal friends. No physician was ever more idolized by his
patients, or more respected by his colleagues. His diagnosis was the
ultimatum ; his opinion, the right court of medical appeals. He gave
himself day and night, when sick as when well, to his work. He went
as readily to the poor as to the rich. All men were equal before the
law of his ready sympathy, kind heart and wondrous skill. He was
self-reliant and resourceful and his presence in a sick-room inspired
confidence and hope.

To his heroic and skillful measures many in this city owe their
lives.

The medical world of North Carolina has acknowledged his eminent
skill throughout the 48 years of his constant work in alleviating the suf-
ferings of mankind.

A years after his return to Charlotte to live, 1870, Dr. Graham and
the late Dr. Johnson B. Jones, one of the greatest physicians of his day,
formed a partnership which was broken only by Dr. Jones's death in
1889.

The late Dr. S. B. Jones succeeded his father in the partnership.

N. C. MEDICAL SOCIETY. 239

I^ater William A. Graham, Dr. Graham's only son, on whom his
father's mantle has fallen, became his partner, and by his valuable
assistance and skill, prolonged his father's life by relieving him of work
that the latter would do, whether sick or well: whether burning with
fever or shaking with a chill.

Dr. Graham held a number of positions in the local and State Medi-
cal Societies. His skill made him conspicuous, always in rank in his
profession a "Saul" among his fellows.

A wail of sorrow comes from hundreds of sick-rooms in Charlotte
to-day for the great physician, the loved friend whose ministry they
will know no more. His place in those homes, in those hearts, must
ever be unique. As his father was esteemed by many "the greatest
statesman the State has produced," so his son will be, to his large
and devoted following, the greatest physician the State has produced.

CITIZEN.

As a citizen he was foremost for the advance of his State and town.
He understood men and measures; inherited a talent for leadership,
and was heeded no less in municipal affairs, when serving often on
the Board of Aldermen of this city, than in medical councils. His
intellectuality was so strong, his foresight and judgment so keen that
his opinion carried weight. Many of the city's best laws and oidinanees
were suggested by him.

He came of the blood that led, not followed. Said Hon. J. H.
Weddington to-day:

"I have known Dr. Graham since the war. He always stood at the
head of all great movements looking toward the advancement of Char-
lotte."

THE MAX.

In his clean life and spotless integrity he kept the faith of his
fathers. A Graham of the Grahams, his character was built on the
white stones of honor, truth, justice, love. He was a broad man. There
was no littleness in him. He was bold, brave, open, candid. He had
opinions and never hesitated to give them when asked. His temper
was even, calm and well balanced. His refinement of nature, his clean-
ness of word and life were his birthrights. He was gentle, kind, charit-
able; tender as a woman in the sick room; generous and magnanimous.
He had a purpose in life, to alleviate suffering, to benefit mankind, and
he fulfilled it. He followed not the clamor of the world, but walked
calmly in his path, turning neither to the right nor left, but keeping
his face ever toward the white light of truth and honor. In his big
heart and high nature there was no room for enmity. In early life
Dr. Graham connected himself with the Baptist Church, that being
the faith of his mother, but his religion rose alcove any creed. It was
the religion of fear of God and love of mankind. He was a close student
of the Bible, and few ever lived its teachings better than he. A man

240 FIFTY-FIFTH ANNUAL SESSION

of great reserve, who permitted few to come within the holy of holies
of his nature, yet he was full of tender sentiment. When the greatest
sorrow of his life came, the death of his eldest daughter, Mrs. Joseph
MacLean, who was loved by all in this community, one of the ministers
of the city Avho called was asked to have prayers. There were many
Bibles in the house, but Dr. Graham loved one best. Turning to his
son, he said, "Will, get my mother's Bible."

Dr Graham was a man of prayer. It was permitted to only a few
to hear the words of prayer which fell constantly, sometimes almost
audibly, from his lips during his illness, but those few will never for-
got those words. They breathed of faith, of love, of "blessed assurance."
He died fortified by the rites of a religion that followed closely the
teachings of the Master.

Of Langdon Cheves a distinguished son of South Carolina, it was
said: "He was above the weakness of vanity and the pettiness of
jealousy." Of Judge William Shipp it was written: "He has laid the
ermine aside unsullied and unstained." Of Vance was it said by his
distinguished colleagues: "He has wrapped his robes about him and
stepped with the faith of a Christian and the dignity of a senator
into the shade of death."

So, Dr. Graham a man "above the weakness of vanity or pettiness
of jealousy," with the "ermine of his profession spotless and pure" has
"stepped with the faith of a Christian and the dignity of a senator
into the beyond to meet and hear the Great Physician say: "I was
sick and ye visited me. * * * Inasmuch as ye did it unto the least
of these ye have done it unto me."

WILLIAM T. HOWARD, M.D.

ME. T. B. KINGSBURY.

There died in the State of Maryland some three weeks ago, August
6, 1907, a very gifted, a most useful and honored physician, Dr. Wil-
liam T. Howard, aged eighty-six. He was born in Mecklenburg Count^^
Virginia, and lived at W^arrenton, N. C, probably a quarter of a century
or more, for it Avas there he practiced his profession with such wonder-
ful success, and laid the foundation for greater work and higher repute.
I knew him slightly so far back as 1849 perhaps, and after 1860 I
knew him intimately, and was his guest at his home in Baltimore in
1868. He was my own physician for years, and administered unto my
family likewise. In 1867, I think it was, he was elected a professor
in the distinguished University of Maryland, and continued to serve
actively until about his 80th year, I suppose when he was made
Emeritus Professor, and retired from active labor. I have understood
that in his last years he interested himself by writing one or two medi-
cal works of some kind, but my information is quite limited here.

If I were a physician, or if I were writing this for physicians, I

N^. C. MEDICAL SOCIETY. 241

would undertake to tell what I really know of Dr. Howard as a practi-
tioner in medicine. He was par excellence the greatest physician I
have ever known or seen. I except no one. The man who was greatest
next to him was of North Carolina birth, a native of Guilford County,
the late Dr. Loton G. Watson, who came near being chosen a Professor
in a Philadelphia ^ledical College, somewhere about 1845 or 1846, and
served for two or three years as a Professor in the Transylvania
University of Kentvicky. He was a man of very unfortunate habits
that wrecked and slew him. He was a genius indeed, and when
the North Carolina Medical Convention met in Wilmington some twenty
years or more, since, I wrote of him at some length, setting forth his
originality and ability. One of the ablest medical men in the Northern
part of our State talking with me in 1870, about Dr. Watson, said
that in 1836, he read medicine under him and that he taught then
the same medical principles and practices that he and Dr. P. W.
Young, his able partner, then were practicing. It was Dr. Montgomery
Paschall.

Dr Howard was a marvelous doctor of physic. His power of diagnosis
was a wonder to some doctors and many of the unprofessionals. I
could fill probably two columns with an account of cases, of which I
am informed, that clearly set forth his greatness, his wonderful gifts
to discover disease, to find out with unerring precision and penetration
just where the battle was raging in the sick person between the attack-
ing disease and nature, the great medicatrix. I know of cases that are
positively most extraordinary, when he readily discovered the real
disease when doctors of repute failed completely. There was one case
I recall in which he at once ascertained a very remarkable disease,
when perhaps a dozen professors in an able faculty had absolutely
failed to discover the real disease.

Dr. Howard was a good looking man of great mental resource and
confidence, who was firm and unyielding when he had made his ex-
amination and study of a case. He held his opinion determinedly
against all comers. I know instances of this kind. He was never
overthrown in his dashes against opposers in the field. He was indeed
a marvel of greatness, and I firmly believe he was beyond fair question
the very foremost physician I ever beheld.

Not to prolong this consideration of the merits of a personal friend.
I make but one more reference to him. I once read, forty years ago,
perhaps it was, a manuscript letter written by the late Dr. John
Buckner (if that is the spelling), a very eminent physician of Balti-
more, from Paris to a personal friend of his. I remember that he told
of several visits to the private clinic of a then famous French doctor.
He said he had seen him examine several patients, and he fully be-
lieved that Dr. William T. Howard, of Warrenton, N. C, was more
than his master in auscullation and percussion. That, remember, was
before my friend had been called to the Baltimore Faculty. I am as

242 FIFTY-FIFTH ANNUAL SESSION

sure of Dr. Howard's supreme greatness in divining and treating dis-
ease as I am of the supremacy of Dr. Howard Kelly of Baltimore, in
the great field of surgery. I have written nothing that I do not be-
lieve, and I could not write less of so accomplished and great a physi-
cian and friend. I once witnessed in Baltimore an animated discussion
and controversy between him and another member of the ]\Iedical
Faculty. It was mainly "all Dutch" to my limited understanding and
information, but I easily recall that Dr. Howard, at last worried by
the prolonged discussion, arose and going to his shelves in his library
( it was there the earnest controversy occurred ) , took down an octavo
and turning to a page — say 304 — walked to the table by which the
other doctor was sitting, and placed the volume opened before him.
Returning he took down another stout volume and opening at — say
407th page — he put it on the other volume. Again he repeated until
four or five volumes, all opened at the precise pages he desired, were
before the astonished competitor. Dr. Howard said: "Now turn there
and read what those eminent authorities say." He did not have any
notes or figvires to guide his memory, but opened each book and from
memory found all he sought or required. I have never seen any other
such manifestation of exact memory of that kind. He not only re-
called what able medical men had written, but turned at once to the
very pages in each volume that contained the judgments. The other
doctor was easily, completely floored.

Dr. Howard joined the North Carolina State Medical Society in
1858, and on his accession to a professorship in the University of JNIary-
land and removal to Baltimore in 1872, was later made an honorary
member, and his name was on the State Society's records as such to the
day of his death.

Dr. Howard was married thrice. I knew well his first wife, an
elegant, handsome, intellectual lady of Warren County, N. C. I am of
the impression that he left no children. His second wife was a refined,
elegant lady from Northampton County. His last wife was from
Baltimore. James Montgomery, an English poet of some fame and
merit, and who was associated in editing with the elder Joseph Gales,
afterwards so well known in Raleigh and in North Carolina, the
Sheffield (England) Register in one of his poems, entitled "Friends."
has this stanza, tender and simple:

"Friend after friend departs;
Who hath not lost a friend?
There is no union here of hearts
That finds not here an end."

DR. T. D. HAIGH, FAYETTEVILLE, N. C.

With a pang of sorrow we chronicle the passing of another of North
Carolina's grand old physicians. The death of Dr. Thomas Devereaux
Haigh, at his home in Fayetteville March 23d, 1908, removes one who.

N. C. MEBICAL SOCIETY. 243

during his active years, was most prominent in the medical profession
of his State. Born in 1828, he had spent his long life of eighty years
in his native town. Dr. Haigh was a graduate of the University of
New York, class 1851. Upon his graduation he began practice in
Fayetteville where he soon become a commanding figure by reason of
his great ability and force of character. In 1874, he joined the State
Medical Society; in 1876, was made Vice-President, and in 1888, he
served as President of the Society. For years he was President of the
Cumberland County Medical Society. Few men have left a stronger
impress for good upon the communities in which their lives were spent.
As a physician he was prominent in his profession, as a citizen he was
a pattern for the younger men about him, as a friend he was constant,
loyal and true. In the home circle his life was a bendiction, as a
Christian his example was in all respects meet for emulation.

Dr. Haigh had not been actively engaged in the practice of medicine
for several years. Because of his advanced age and failing strength,
he had been forced to retire. He is survived by his wife and seven
children.

DR. LAWRENCE EDWARD HOLMES.

Dr. Lawrence Edward Holmes was born at Birmingham, England
on January 26, 1873. His father and mother with their six children
left England and settled in Henderson County, North Carolina, in the
end of the year 1881. From 1883 to 1889 he was a pupil in a private
school taught by Frank Valentine, U.A., of Cambridge University,
England. In 1890 at the age of seventeen he entered the sophomore
class at the University of Tennessee, where he graduated with the degree
of B.A. in 1893. During this time he always stood at the head of his
classes in literature and language. While at the University of Ten-
nessee he became a member of the Kappa Alpha fraternity.

On leaving the University of Tennessee in 1893, he entered the Medi-
cal School of the University of Pennsylvania, where he graduated with
the degree of M.D., with high honors in 1897. While at the Medical
School of the University of Pennsylvania he made the highest average
four years record of any man in his class, besides winning several
prizes for excellence in special subjects.

After graduation at the Medical School he spent two years as resi-
dent physician at the Episcopal Hospital, Philadelphia. On leaving
there he spent a year traveling in Europe and Asia as private physi-
cian. On returning to this country in 1900 he accepted the position
of resident physician to the Clarence Barker Memorial Hospital at
Biltmore, N. C, with which institution he remained intimately con-
nected up to the time of his death. In 1904 (or 1905), he opened an
office in Asheville and built up a considerable practice there in addition
to his practice at Biltmore and the surrounding country.

244 FIFTY-FIFTH ANNUAL SESSION

During the severe weather of January, 1908, he seemed to have
been very much overworked, and to have gotten in a run down con-
dition, and contracted grippe and pneumonia, from which he died on
February 5, 1908, after an illness lasting six days.

He was a very active member of the Protestant Episcopal Church,
and at the time of his death was a vestryman of All Souls' church,
Biltmore.

DR. ROBERT H. HOLLIDAY.

Dr. Robert H. Holliday was born in Preston, England, A. D., 1841,
and died in Clinton on Friday, March, 13, 1908, at the age of sixty-
seven years.

As a boy in his native country, young Holliday was filled with the
ambition, so common to English boys of his day to become a sailor,
and served an apprenticeship in the pilot service and later sailed
for this country, landing at the port of Wilmington, N. C. Be-
coming tired of the life of a sailor, although still a boy and a stranger
in a strange land, he left his ship and after various experiences came
with Mr. Bryant Newkirk to his home in the Black River section and
was received with great kindness into Mr. Newkirk's hospitable family.
He attended the neighborhood school and made many friends. Soon
afterwards the Civil War began and young Hollidaj^ volunteered and
joined the Wilmington Rifie Guards, and as a true and loyal son of
his adopted land went at once into active service as a soldier. He
was wounded in the knee in battle in Virginia and for a time disabled
for active service in the field and was assigned to ordnance duty at
the Confederate Arsenal at Fayetteville, N. C. Some months later he
was elected First Lieutenant of Company F, Second North Carolina
Battalion and served with gallantry until the close of the war.

When Sherman's army marched and straggled and foraged and
pillaged through this region, Lieutenant Holliday was at his home on
furlough and together with Parson Colin Shaw and others, organized
a company known as "Shaw's Bushwhackers," which did good service
in harassing Sherman's bummers and protecting the homes of the
Black River country and lower Cape Fear.

During all his life Dr. Holliday maintained a great interest in every-
thing connected with the Civil War, and was for many years commander
of the Confederate Veterans of Sampson County.

After the close of the war Lieutenant Holliday returned to his old
home and applied himself to the study of medicine under Dr. Seavey,
a prominent physicion of the county, and afterwards was graduated
from the Baltimore Medical College and located in the western part
of Sampson County for the practice of his profession.

Here he spent many years and acquired an extensive covmtry practice,
and made many friends. He was married to Miss Delia Fisher, who
with three sons and a daughter now survive him. About the year

N. C. MEDICAL SOCIETY. 245

1885, Dr. Holliday removed with his family to Clinton, and with his
son, :Mr. R. W. Holliday, conducted a drug store and office practice
until his death.

His genial nature and broad sympathies and loyal friendships had
won him hosts of friends. He had been for many years a prominent
member and officer in St. Paul's Episcopal Church in Clinton. He had
served several terms as mayor of the town of Clinton. He died as he
had lived; loyal to the Christ in whom he trusted; loyal to the church;
loyal to the country of his adoption, and to her lost cause, for which
he was ready to give his life; loyal to his mother country and rejoic-
ing in England's greatness; loyal to his friends; devoted to his family.
He is gone and we shall miss the sunshine of his presence and the
inspiration of his unfailing optimism.

"Twilight and evening star,
And one clear call for me;
And may there be no moaning of the bar
When I put out to sea.

"Twilight and evening bells.
And after that the dark.
And may there be no sadness of farewell
When I embark.

"But such a tide as moving seems asleep
Too full for sound and foam.
When that which drew from out the boundless deep,
Returns again home.

"But though from out the bourne of time and place
The flood may bear me far,
I hope to see my Pilot face to face
When I have crossed the bar."

DR. J. F. BEALL, LEXINGTON, N. C.

Dr. J. F. Beall was born at "Beallmont," his ancestral home near
Linwood, Davidson County, September 1st, 1837, and resided there most
of the time until he departed this life on the 7th of December, 1907.

Having completed his education and prepared himself for the pro-
fession of a physician, and the war between the states coming on, he
entered the Confederate Army as a private and for gallantry and good
conduct as a soldier, he was promoted to the rank of major of the
21st regiment and took part in all the principal battles of the Army
of Northern Virginia from Manassas to Petersburg, often gallantly
leading the regiment in battle in the absence of the colonel. He re-
ceived five wounds and carried to the grave these honorable marks of
his devotion to a just cause. Some years ago he wrote a most interest-
ing history of the 21st regiment and it has a prominent place in the war

246 FIFTY-FIFTH ANNUAL SESSION

records of tlie North Carolina troops. After the war he entered upon
the practice of his profession as a physician and pursued the same for
years with great skill and success.

In 18G9 he was married to Miss Margaret Cornelia Harper, of Cald-
well County, and she and three children, Frank H., Carrie M. and
James J., survive to mourn their irreparable loss.

In politics Dr. Beall was a firm and consistent Democrat but tolerant
and considerate of the opinions and political feelings of opponents. So
popular was he that against his wishes and protest he was nominated
and elected to the State Senate of 1882-3, and made an able and active
member of that body.

He was for years a member of the Presbyterian Church, leading a
faithful and consistent Christian life, illustrating the sustaining power
and blessedness of Christianity by bearing with patience and cheerful-
ness the pain of sickness which came upon him in his latter years.

Dr. Beall was a man of superior natural gifts, well-informed, noted
for sterling integrity of character and high sense of honor, genial and
pleasant in manner and a man of great force of character. Faithful
and honorable in all the situations of life, he has gone to enjoy the
reward of the righteous.

DR. J. D. McMillan, lumberton, n. c.

Dr. J. D. McMillan of Lumberton, died in .James Walker Memorial
Hospital, at Wilmington, Wednesday morning, March 7th, 1908. Dr.
McMillan had not been well for several weeks, but attended to his
duties and visited his large number of patients until Tuesday of last
week, when he was taken very ill, and Dr. Bullock of Wilmington was
telegraphed for. He was taken to Wilmington on Saturday night,
and an operation for obstruction of the bowels was performed Sunday
morning at eleven o'clock, but little hope for recovery was felt by his
physicians. The remains were brought to Lumberton Wednesday after-
noon and interred in the cemetery Thursday afternoon at three o'clock.
The funeral took place in the Presbyterian Church, of which he had
been a consistent member for over thirty years. The funeral services
were conducted in an impressive manner by the Rev. A. F. Baker.
The pall-bearers were: L. A. McAllister, N. J. Thompson, K. M. Biggs,
C. B. Townsend, B. M. Davis, A. Nash, A. H. McLeod and W. P. Mc-
Allister. The physicians of the town and visiting physicians attended
the funeral in a body. The church was draped in mourning by loving
hands.

Dr. McMillan was born on September 11th, 1850, at Parkton, N. C,
this county, and graduated in medicine at the Jefferson Medical Col-
lege of Philadelphia, in 1876. He located in Lumberton shortly after
receiving his diploma and had been a resident of the town since that
time. He twice married. His first wife. Miss Sarah E. McMillan, of
Parkton, died in 1882, leaving one son, John D. McMillan. Two years
later Dr. McMillan was united in marriage to Miss Belle Rowland, of

X. C. MEDICAL SOCIETY. 247

Lumberton, who with one daughter, Miss Flora Xeill McMillan, survive
him. Dr. McMillan had one of the largest practices of any physician
in the county and the love felt for him as a physician and friend was
great. His life was a most exemplary one. A man of gentle, dignified
and noble bearing, a heart which felt for all in distress, straightfor-
ward and open in all his dealings, he leaves countless numbers of people
to mourn their loss.

DR. ELIAS KEENER, KERNERSVILLE, N. C.

Dr. Elias Kerner died at the home of his son, Mr. J. F. Kerner, at
Kernersville, N. C, on the morning of July 22d, 1907, at 9 o'clock,
after an illness of several months. Dr. Kerner was born February 1,
1826, and was therefore in the 82d year of his life. He had suffered
greatly recently with rheumatism of the heart which was the immediate
cause of his death. He was a successful practicing physician for more
than 55 years, and was a great friend to the poor, and will be greatly
missed in this community. He served a term in the Legislature of
North Carolina during the Civil War.

The funeral services were conducted from the Moravian Church by
the pastor. Rev. E. S. Crossland, of Winston-Salem, after which the
remains were laid to rest in the Moravian Cemetery.

DR. RANDOLPH VAMPIL, LUMBERTON, N. C.

Dr. Vampil died at his home in Lumberton, N. C, September 17th,
1907, aged 86 years. He was one of Lumberton's most prominent physi-
cians and was reputed for his high character and large wealth. He
moved to Lumberton from Charlotte twenty-five years ago, and practiced
medicine successfully for a number of years. He is survived by one
daughter, Mrs. W. W. Carlyle, of Lumberton.

DR. R. C. WASHBURN, GREENSBORO, N. C.

Dr. R. C. Washburn died November 28th, 1907, of blood poisoning
at St. Leo's Hospital, Greensboro. He had resided near Guilford Battle
Ground for twelve years where he devoted his whole attention to farm-
ing and merchandising.

DR. C. L. BRYAN, TRAP HILL, N. C

DR. M. W. HARPER, DUNN, N. C.

DR. S. B. KENNEDY, WINDSOR, N. C.

DR. H. A. McSWAIN, WADE, N. C.

DR. ROBERT ROBERSON, WAXHAW, N. C.

248 riFTY-rirTH Ax:sruAL session

DR. C. H. LEWIS, FARMERS, N. C.

Dr. C. H. Lewis died April 23d, 1908. He was a student at Jefferson
Medical College, in 1878. For several years he was a member of the
North Carolina Medical Society and also of the Randolph County
Medical Society. Heart disease was the cause of his death. He was
buried at Farmers, N. C, under Masonic honors.

DR. J. J. IMANN, LOUISBURG, N. C.

Dr. J. J. Mann, one of Louisburg's leading physicians, died on May
29th, 1908, of heart failure after just a short illness. Tlie funeral
services were held in the afternoon at 5 o'clock. Rev. George M. Duke,
officiating. A large procession followed the remains to the grave to
pay the last respects to the deceased's memory. He was about forty
years of age and leaves a brother, Mr. W. Hal Mann, and two sons,
Joseph and Pell Mann, and one daughter. Miss Ruth Mann.

DR. JOHN D. SPICER, GOLDSBORO, N. C.

Dr John D. Spicer, one of Goldsboro's most eminent physicians, died
on June 8th, 1908. For many years he has stood at the head of his
profession and kept up his practice until only a few days before his
death. Dr. Spicer was a native of Onslow County, coming to Golds-
boro soon after the war. He was a graduate of the State University,
and an active member of its Alumni Association. He is survived by a
devoted wife, and eight children, four sons and four davighters, and
a large number of relatives. The funeral was held on June 9th, con-
ducted by Rev. F. W. Farries, pastor of the Presbyterian Church.

DR. JASPER LEE BEAM.

Dr. Jasper Lee Beam was born in Lincoln County, N. C, March 7,
1868, and received his medical degree from the Atlanta College of Physi-
cians and Surgeons in 1899, and the Baltimore Medical College in 1904.
He practiced his profession at Crouse, N. C. This being his home at
the time of his death, which occurred October 2.5th, 1907.

Dr. Beam was a man who was held in high esteem by all classes
of people, both laymen and medical. He was a member of the Noith
Carolina Medical Society and Lincoln County Medical Society. He
was a member of the E. Lutheran Church.

He leaves a wife and one son, and several brothers and sisters to
mourn his decease.

JAMES HERBERT REYNOLDS, M.D.

Dr. James Herbert Reynolds was born on the 27th day of August,
1878, in Asheville, N. C. He received his preliminary education at
Bingham School, Asheville.

jS". c. medical society. 249

At the beginning of the Spanish American War, he early volunteered,
and was Sergeant in Company H.

After the war, and when his eompanj' was discharged, he took up
the study of medicine, graduating from the Loviisville Medical College
in the year 1903.

Immediately after his graduation he became associated in the practice
of his profession, Avith Dr. James A. Burroughs, of Asheville, N. C.
Though at the time of his death. Dr. Reynolds had been practicing
less than five years, he had made an enviable reputation, commanding
the respect, confidence and esteem of his professional brethren. His
sterling worth and ability won public recognition. And he was af-
fectionately regarded by all with whom he was intimately thrown.

He was true to his Scotch-Irish ancestry, a gentleman in all things.
Jealous of his own rights and honor, he was in consequence singularly
considerate and thoughtful that neither the rights nor honor of others
would suffer by wrongful act of his. Unassuming and retiring in dis-
position, he was, nevertheless, aggressive and fearless in answering
duty's call.

He faced the end with a fortitude indicating a past void of offense,
and a fearlessness which showed his faith as to the future.

But for his untimely death, which occurred on June the third, there
can be no doubt but that age would have fulfilled the promises of
youth, and that his career would have been peculiarly useful and dis-
tinguished.

DR. WILLIAM RHODES CAPEHART.

William Rhodes Capehart was born at "Scotch Hall," in Bertie
County, October 31st 1836. His parents were representative of all
of the old families in this part of the State. On arriving at manhood
he read medicine in New Orleans and began practice. He was a sur-
geon in the Confederate Army and saw service in both field and hospital.

At the close of the war he located in Edenton to practice his pro-
fession. Here he was the friend and peer of those eminent surgeons
and doctors, Richard Dillard, Sr., W. A. Norcom and Edward Warren.

In 1872 he purchased the magnificent Avoca Farm and Sutton
Fishery. Later he moved there to live, and then practically quit the
practice of his profession. Quite often he yielded to the importunity
of those who knew his great skill and rendered professional services.
He was often called in consultation with other physicians. In medicine
his great strength lay in his fund of practical horse sense. He knew
how and what to do. His judgment in sickness was almost unerring.
He is best known as a farmer and fisherman. The "Avoca Farm" is
one of the best in the State. The late Cullen Capeheart, one of the
State's ablest sons, had brought it to a state of high cultivation and
fertility. It is in the fork of Salmon Creek and Chowan River. It is
indeed "the vale of Avoca where the sweet waters meet."

250 FIFTY-FIFTH ANNUAL SESSION

Here foi- a generation Dr. Capehart conducted his farming operations
with intelligence and skill. He used improved implements. He knew
the quality of his soils. He knew the needs of every acre. He built
silos. He planted grasses. For years he was a successful stock breeder.
He was a lover of a good horse and kept good horses for his own use
and for his farm. He was an extensive fisherman. He was one of
the pioneers in icing fish and in the use of machinery in hauling his
seines. The Avoca Fishery became widely known. The magazines
sent special correspondents there and published many illustrated articles
about it. The United States Government established a branch of its
shad hatching operation there. For many years he was a member of
the Board of Agriculture. Here his ripe judgment, progressive ideas
and rich experience made him a most valuable factor in bringing the
State and its resources before the nation. He had a beautiful home.
It was heated, watered and lighted by his own plant. It was indeed
baronial in its splendor.

The secrets of his success were energy, industry, hopefvilness, good
cheer. Just after the war he had faith in the South and he went in
debt sixty thousand dollars for farm and fishery. He conquered and
left a fine estate.

He was the only son of George Washington and Susan Martha Cape-
hart. He was a dutiful son. No day passed without a visist to his
parents. He had three sisters who survive him: Miss Susan Martin
Capehart, of Scotch Hall ; Mrs. Sophy Martin, of Florida and Mrs.
Mary M. Capeheart, of Elmwood. A few days before his death they
were all radiant in a family reunion. He was a most devoted brother.

In December, 1879, he married Miss Clara Cotton Bond, of Edenton,
N. C. She is a true type of the refinement and culture of that town.
Two children with her mourn the loss of father and husband, William
Cullen Capehart, who will fittingly succeed the father and Miss C. C.
Capehart, who typifies the mother of this family, whose home was the
scene of great domestic happiness and splendid hospitality. Dr. Capehart
was buried at his home near his kindred, with the ceremony of the
Episcopal Church, Rev. J. B. Gebble rector, officiating. His former
slaves and their sons bore his body from the hall of their former master
and also true friend. More than three hundred colored people were
present. A very large number of people attended from Edenton, Nor-
folk, Windsor and other towns and from Bertie County.

And so at the end of three score and ten this knightly gentleman
fell asleep on the watches of the night. His life's account closed after
a successful journey. He did his work well. His deeds will speak for
him.

2^. C. MEDICAL SOCIETY. 251

The President's Annual Address.

RANDOM XOTES ON THE HISTORY, AIMS AXD
PURPOSES OF THE MEDICAL SOCIETY OF
THE STATE OF NORTH CAROLINA: BEING
THE ^'PRESIDENT'S ANNUAL ADDRESS" ON
THE OCCASION OF THE FIFTY-FIFTH AN-
NUAL SESSION OF THE MEDICAL SOCIETY
OF THE STATE OF NORTH CAROLINA, HELD
IN THE CITY OF WINSTON-SALEM, N. C,
JUNE 16, 17 AND IS, 1908.

BY J. HO^A•ELL WAY. M.D., WAYNESVILLE, N. C.

Fellow Members of the Society: — Only the favored few
who have been by your kind partiality thus similarly placed
can fully appreciate the genuine difficulty I have experienced
in the selection of a subject for my remarks to you to-day.
A glance at the very elaborate and complete program of
papers arranged for consideration at this meeting suggests
the pertinent fact that practically every department of medi-
cal science and art will be covered by the various essayists
who follow me, hence for your President to attempt the dis-
cussion of some purely medical theme would be, to say the
least, superfluous. Excluding then, as I have done, topics
technical or scientific, from serious consideration as befit-
ting the President's address, the field of election is materially
narrowed, and after due deliberation I have decided to invitt::
your attention to some random thoughts relative to the his-
tory, aims and purposes of the Medical Society of the State
of North Carolina.

But before engaging in some observations along these
lines I can not forbear again expressing to you my profound
appreciation of the honor of presiding over the fifty-fifth an-
nual session of this learned body of near twelve hundred
members. The Medical Society of the State of North Caro-

252 FIFTY-FIFTH ANNUAL. SESSION

lina is in deed and in truth a great and a grand organiza-
tion, and our coming together to-day on the historic soil of
old Wachovia, from whose sacred precincts have in past gen-
erations emanated so many noble and inspiring impulses for
the elevating of the moral, educational and sound financial
uplift of our great commonwealth, is a pleasing and an en-
nobling spectacle.

But delightful as is this fine sisterhood of twin cities in a
social way, alluring and inviting as are her many attractions,
it is not these alone which impel our presence in Winston-
Salem to-day. Our coming together in this annual conclave
is not without great sacrifice on the part of every one present,
but the reason is not far to seek. We are here because we
have ideals. Each of us would elevate and uplift higher and
higher the professional standards of the medical profession;
we would add to our individual stores of learning ; we would
seek to impart one to another the helpful experiences of the
past year; we would gather fresh inspiration for the labors
and the toils of our daily vocation of helping to better health,
better life, better ideals, those whose all is daily committed
to our care. Xot one of us has a plan or a practice wholly
flawless, nor do we as individuals even hope to evolve such ;
but in union there is strength, in counsel there is wisdom ;
thus annually do we find our great body of the elect of the
State's great medical profession gathering together at some
appointed place and striving for our ideals. And it is well
that we do. Much has been accomplished in the past three-
score years since the evolution of the times brought this So-
ciety into existence; but while much has been done in the
past, there yet remains even greater achievements to be real-
ized ere it can be truly said our work is done.

We have before us the examples and the ideals of the men
of this body of the past generations, worthy leaders of a
noble profession. The eloqvient and resourceful Edmund
Strudwick, our first President, and his worthy successors, the
talented X. J. Pittman, the greatly beloved Will George

]Sr. C. MEDICAL SOCIETY. 253

Thomas, the brilliant E. Burke Haywood, the accomplished
Marcelliis Whitehead, the devoted S. S. Satchwell, the learned
Thomas F. Wood, the gentle J. H. Tucker, the noble Charles
J. O'Hagan, the skilled alienist P. L. Murphy, the physician-
patriot Joseph Graham, the erudite Thos. D. Haigh and Chas.
E. Johnson, R. L. Payne, J. J. Summerell and their com-
peers— noble leaders of an erudite profession whose lustrous
fame is our most sacred heritage as well as our ever-present
stimulus to more exalted ideals and nobler effort !

These noble names are engraved high in Xorth Cai'olina's
Hall of Medical Fame, and yet (if need be, with apologies
to the living) I may add that a future generation will place
alongside of these fallen leaders of ours, and alike revere the
names of the courtly Henry T. Bahnson, the kindly George
G. Thomas, the affable Eichard H. Lewis, the tried and true
friend W. H. H. Cobb, the student Francis Duffy, the care-
ful and precise A. W. Knox, and Eobt. S. Young and H.
Bascom Weaver and Edward C. Register and genial David
T. Tavloe will be remembered as amono- the stroua; and force-
ful men of the profession who have been active, vital forces
in the Society for years, graced the presidential chair and
exercised a helpful influence upon the profession of our loved
State.

It has been observed with apparently much truth that
most human progress has been in the main in cyclic move-
ment; an idea is advanced by a few enthusiasts in one gen-
eration, rushed to the forefront, where for a time it receives
much attention, later it passes to the rear of the stage un-
noticed, and later is unceremoniously shuffled off the stage
into oblivion, where it quietly rests until rescued by some
worker who delves beneath the superficial area where most
of us are content to dig. That this axiom is as applicable
to medical organization as to other forms of human en-
deavor does not admit of successful contradiction. Within
the one hundred and thirty-two years of our national exist-
ence there have been apparently no less than three distinct

254 FIFTY-FIFTH ANNUAL SESSION

periods of activity in the medical profession — three distinct
periods when the physicians of the country have sho'wn a
manifest disposition to cease their fruitless bickerings, come
together and to work for the development of means and
measures calculated to enlighten and educate public senti-
ment in such ways as will help both people and profession,
and to impress ourselves en masse upon the body politic as
possessing those admirable qualities of head and heart for
which the individual members of our profession are so highly
regarded.

In the period of organizing the various affairs of the only
recently detached colonies of Great Britain, there was a great
tendency to organize along many and different lines of hu-
man effort, and it was a very natural thing that our profes-
sion, finding itself cut loose from the mother country and its
medical institutions, should essay the founding of medical
schools and the organization of medical societies also. Fol-
lowing the founding of the Federal government in the closing
years of the eighteenth century, there was organized some
five or six medical colleges and about the same number of
State societies. !N"otable among the State medical societies
were those of IS^ew Jersey (organized just prior to the Revo-
lution), Massachusetts, Xew Hampshire, Connecticut, ISTew
York, and on December 1, 1800, in the city of Raleigh, N". C.
there was organized the Medical Society of Xorth Carolina
with Richard Fenner, of Franklin, President ; Nathaniel
Loomis and John Claiborn, Vice-Presidents ; Calvin Jones,
of Raleigh, Corresponding Secretary, and Wm. G. Hill, of
Raleigh, Recording Secretary, with Cargill Massenburg, of
Wake County, Treasurer. James Webb, of Hillsboro ;
James John Pasteur and Janson Hand were elected Censors.
Steps were taken to establish at the St&te Capital a botanical
garden, in which it was proposed to cultivate and develop
all herbs useful in medicine. Prizes aggregating no less
than $85 were offered for the best specimens of opium, fox-
glove, castor oil, senna and rhubarb. At the meeting in Ra-

N. C. MEDICAL SOCIETY. 255

leigh ill 1802 Dr. Osborne, of jSTew Bern, was elected Presi-
dent. Dr. John Armand DeRossett, of Wilmington, who
married a niece of David Hume, the historian, graduated
from Princeton and studied medicine under Dr. Benjamin
Rush in Philadelphia, is also thought to have been a mem-
ber of this first State Society. And while the records of the
work of this Society are very meager indeed, yet it is kno^vn
that the medical gentlemen composing it were among the
very first men of their times professionally and socially, and
it is evident they must have made some impression, for in
the revived State Medical Society in 1850 Dr. James Webb,
of Hillsboro, was, on motion of the President, Dr. Edmund
Strudwick, elected to honorary membership, and his connec-
tion with the older Society noted at the time. Dr. DeRossett,
then a gentleman retired from active practice and in ad-
vanced years, was also elected to honorary membership. Dr,
Strudwick, on retiring from the chair, delivered a beautiful
oration in which he said, referring to the Society and the
profession: "J^either the apathy of friends, the cold neglect
and deep injustice of legislation, nor pampered quackery and
empiricism can stay its onward course. True medical science
will, like the majestic oak, withstand the shock and storm of
every opposition. It has been beautifully compared to a
star whose light, though now and then obscured by a passing,
cloud, will shine on forever and ever in the firmament of
heaven." Dr. Strudwick in this address also made reference
to the fonner organization of the State Medical Society and
adjured his auditors to "see that we avoid its fate."

While the State Medical Society of jSTew Jersey had been
organized in 1766, thus antedating the Declaration of Inde-
pendence at Philadelphia some ten years, and several other
State societies had been organized at later dates, yet the most
decided impetus to medical organization in the United States
was given by the American Medical Association by its pro-
mulgation shortly after its organization of that most remark-
able of professional documents known as the "Code of Medi-

256 FIFTY-FIFTH ANNUAL SESSION

cal Ethics." This most valuable ar.d instructive of pro-
fessional productions remained for more than fifty years,
without scarce the "dotting of an 'I' or the crossing of a 'T/ "
the universally accepted concrete wisdom of the American
medical' profession as to the conduct of medical gentlemen
in their relations to each other and to the j)ublic. It may
even be doubted if Dr. Nathan Smith Davis and Dr. H. J.
Bigelow, and their illustrious confreres, fully realized how
well they builded in the construction of the "Code," but im-
questionably its influence in helping to keep medicine a pro-
fession and not a trade has been most beneficent, and it may
well be argued that this Code of Medical Ethics has wielded
an influence far beyond the confines of the medical profes-
sion. En passant, it is of interest to note that the American
Bar Association, the great national society representative of
the best interests and standards of the legal profession, has
now a committee at work preparing a "Code of Legal Ethics"
which is expected to be adopted at its forthcoming session
for the ''rule and guide of faith and practice" as regards the
relations of members of that honorable profession to each
other and to their clients.

That the time did come when the strong leaders of the Na-
tional Medical Organization deemed its revisal the part of
wisdom — as they did in 1900 and 1901 — is not at all strange.
The Bible itself and the creeds of the various religious faiths
have, from time to time, been the subjects of critically care-
ful revision at the hands of their friends !

The effect of the organization of the American Medical
Association in New York in 1846, along broad and compre-
hensive lines, the adoption of its celebrated "Code of Medi-
cal Ethics," and the wide dissemination given the latter
among the medical men over the nation was indeed stimu-
lating and helpful to the cause of medical organization every-
where. The physicians of North Carolina, who were mem-
bers of the State Legislature which met at Raleigh in the
winter of 1848 and 1849, discussed the situation with the

X. C. MEDICAL SOCIETY. 257

Wake County doctors, and resolved that Avitliiii themselves,
in association with the Wake meniLers of the profession, they
would set in motion plans to organize the Medical Society
of the State of Xorth Carolina, a Society to be allied with
and in operation under the great i^ational Medical Associa-
tion such as was already in existence in several of the States
After several free discussions of the important subject in
Raleigh it was decided in February, IS-iO, to issue an address
to the phj'sicians of Xorth Carolina urging the coming to-
gether at Ealeigh for the purpose of organizing a State Medi-
cal Society. Pursuant to this call on April 16, 1849, there
came together at Raleigh from seven counties outside of Wake
thirteen physicians, Avhich, with the thirteen gentlemen of
the Raleigh and Wake profession, made a total attendance
of twenty-six in attendance at the organization. While the
attendance outside of Wake County was quite disappointing
yet, after careful consideration, those present effected the
organization of the Medical Society of the State of Xorth
Carolina with the following officers:

President, Dr. Edmund Strudwick, Hillsboro; Vice-Presi-
dents, Drs. Haywood, Johnson, Williamson and Thomas ;
Secretary, Dr. Wm. H. McKee, of Raleigh, with Dr. Wm. G.
Hill, of Raleigh, Treasurer.

A two days session was held, during which the recently
promulgated ''Code of Medical Ethics" of the American
Medical Association was reported by a special committee who
had it under advisement, and with the elimination of a single
item it was adopted unanimously. As indicative of the ex-
ceeding high-toned, and, as might possibly be said at this time,
ultra-ethical standards of these charter members of our State
Society in their fine conception of professional courtesies to
each other in practice, it is of interest to note the eliminated
article of the "Code." It reads as follows:

"In obstetrical and important surgical cases, which give
rise to unusual fatigue, anxiety and responsibility, it is but

258 PIFTY-riFTH ANNUAL SESSION

just that the fees accruing therefrom should be awarded the
physician who officiates."

When I became a licensed physician in 1885 the Transac-
tions of the State Medical Society published the ''Code of
Medical Ethics of the A. M. A. as its own Code, but a care-
ful review of the Transactions of that body fails to show
where or when the eliminated item was restored. I have often
doubted if it really was restored, but more than likely crept
into the volume in the publishing. Once in it remained un-
noticed, until at Hot Springs in 1903 (another half-century
as between the 1800 and the 1849 organization of the X. C.
State Society) when, again following the footsteps of the pa-
rent organization, Ave adopted the revised Code, or, as it is
now called, ''The Principles of Medical Ethics" of the Ameri-
can Medical Association.

From the organization meeting in Raleigh in 1849 were
appointed as delegates to the A. M. A. Drs. T. N". Cameron,
N. J. Pittman and Johnston Jones. Of these Dr. Pittman
attended the session in Boston in 1849, a few days after the
organization of the State Society. His report to the next
session of the State Society of the trip to the meeting, the
great national leaders he met there, the important measures
discussed, was a delightfully worded production for which
he received a vote of thanks from the Society.

At the 1850 session delegates from the newly organized
County Societies of Hyde, Beaufort, 'New Hanover, Edge-
combe, Mecklenburg, Piedmont, Orange, Granville, Nash
and Franklin w^ere present, and after having the constitution
of their societies examined were admitted as members. Thus,
as was forcefully directed to our attention by President Knox
in his admirable President's address at Hot Springs in 1903.
the earliest organization of the present Medical Society of
the State of North Carolina rested on the basis of organized
local societies. In effecting a reorganization at that meeting,
under Dr. Knox's wise leadership, we have merely reverted
to primal principles, or in other words building the medical

X. C. MEDICAL SOCIETY. 259

organization of the State from the foundation upward instead
of from the to^D downward ! The division of our present So-
ciety session into a House of Delegates and the General Meet-
ing was the inevitable, logical and necessary result of activi-
ties which greatly increased our annual attendance. Should
future management of the Society's affairs be such as to pro-
duce the decline of the County Societies and a diminished
interest in the meetings of the State Society, a recurrence to
the methods of transacting business as in vogue in 1900 could
readily enough be brought about. But the chief business
of our annual gathering together being the reading and dis-
cussion of scientific papers, and -^dth the wealth of doctors we
now have who delight in this work, it is inevitable that the
General Meeting should continue to be wholly devoted to such
duties. Our House of Delegates, *'The legislative and busi-
ness body of the Society," being made up of the elected rep-
resentatives of the local profession from every section of the
State, certainly gives fairest consideration of business propo-
sitions, and in voting in the various elections each imit of
our great State organization votes exactly its proper and legiti-
mate strength, thus eliminating the possibility of the men
within a radius of fifty miles or less of the Society's meeting
place exercising undue control in the Society's affairs.

There is another interesting thought in this connection
that I may be pardoned for referring to thus publicly, and
it is this : If there exists in the minds of any of our mem-
bers a yearning desire to participate actively in the "business
and legislative work of the Society" (and such desire is per-
fectly legitimate and honorable when methods used are not
open to objection), those members must actively affiliate and
fraternize with the members of the local profession in their
home County Society, and the wisdom of thus entrusting the
affairs of the profession to the members who are active work-
ers for the general good of the profession in their home com-
munities is eminently correct and proper, even if not, as has
been hinted at times, wholly approved of by gentlemen who

260 FIFTY-FIFTH ANNUAL SESSION

would participate actively in the "business and legislative
affairs of the Society'' while not caring to be even connected
with local medical organizations with their neighbor physi-
cians. Parenthetically, it affords me great pleasure to ob-
serve in this connection that at no time since their reorgani-
zation in 1903 have the helpful influences of the numerous
County Societies upon the general welfare of the profession
been more manifest than in the past year.

The Society meeting of 1850 showed itself fully alive to
public as well as professional needs in advising the enactment
of State legislation providing for "a general registration law
for births, deaths and marriages" ; certainly a worthy sug-
gestion and one which after fifty-eight years is still a "long-
felt want" in the minds of those who believe in the proper
tabulation and collection of the vital statistics of civilized
States. At the present hour this remains one of the legacies
of incompleted legislation which has been handed down from
a previous generation. I trust the State Board of Health
will have the cordial cooperation of every member of this
body in securing at an early date some much-needed enact-
ments on this line.

The session of 1850 increased the annual dues of the State
Society from $3 to $5, and designated a committee to "report
on the propriety of establishing a medical college in this
State." This committee, without saying why, did not report
for two years, and then advised adversely, because "it was
feared the best men of the profession would not give up their
practice and come together in one place to teach medicine,"
because it was apprehended that anatomical material could
not be secured in sufficient quantity; and further, "because to
graduate any but first-class physicians in JSTorth Carolina
would be to foster a species of quackery." They also depre-
cated the establishing of unendowed medical colleges. Their
report on the "college question" was unanimously adopted,
and was strikingly similar to one presented by a committee
and adopted by the Asheville meeting of the Society in 1891,

N. C. MEDICAL SOCIETY. 261

the committee being composed of three young men (W. P.
Beall, Frank W. Brown and J. Howell Way) neither of whom
were in the least degree familiar with the action of the State
Society on the same subject some forty years previously. But
the jDrofessional sentiment in Xorth Carolina as to medical
colleges has undergone a change since then, and to-day good
work is being done in ISTorth Carolina colleges of medicine. I
commend to your thoughtful consideration the suggestion
that of the five hundred young men of this State now engaged
in studying for the degree in medicine, at least two-fifths of
them are at work in our own colleges, being taught the princi-
ples and the art of medicine in small classes by competent in-
structors who stress disease conditions as actually seen in our
climate and environs. Without being tedious upon this theme
I wish to also note the fact that some of the most promising
of the younger members of the profession are to be fouad
among the alumni of our local colleges of medicine. Medical
science knows no geographic limitations, yet it is w^ell the
profession and the peoi>le generally of the State should knovv^
the successful work the colleges of medicine are accomplish-
ing in our own State and encourage them with our symiDathy
and support.

The Society also at the 1850 session passed resolutions
urging the N^ational Congress to "adopt measures to improve
the condition of the medical service of the army and navy" ;
also a resolution decrying as reprehensible "the practice of
taking care of families at a stipulated price per annum." The
distinguished Dr. Chas. E. Johnson, of Raleigh, at this meet-
ing addressed the Society at length "upon the vast difference
in the radiating properties of the black and white skins," a
topic about which a large volume has been recently written.
I refer to these various questions before the State Society
fifty-eight years ago as shoAving they were thoroughly alive
and alert as to professional conditions and needs in both
State and nation.

The influence and prestige of the State Medical Societv

262 riFTY-FIFTH ANNUAL SESSION

gi-ew from year to year, but not without earnest and pains-
taking effort on the part of those entrusted with leadership
in its affairs. In 1852 a committee of Drs. J. H. Dickinson,
J. Graham Tull, S. S. Satchwell, Chas. E. Johnson and Will
George Thomas, as chairman, issued a ''General address to
the physicians of ISTorth Carolina," urging their duty to assist
in the organization and enrollment of all practitioners of
regular medicine of the State in the County Societies. In
this "Address," penned by one of the State's most gifted sons
and talented physicians of that century, occurs the following
language: "Take the earliest opportunity to join the local
medical society, attend its meetings and freely participate in
its proceedings," and later on he says :

'Tt is useless to argue this matter further. It is by the
magic power of associated effort — the grand idea of the pres-
ent age — that existing evils and errors in the profession can
be most effectually eradicated, and hence the vital importance
and necessity of these medical societies. It is to the unity of
design and concentration and power of action, which associa-
tion in a common cause gives, that all the arts, sciences and
occupations of life are greatly indebted for the rapid strides
they are making. It is giving a mighty impulse to the human
intellect, as seen in the wonderful progress of the physical
sciences, education, mechanics, commerce, agriculture and the
various benevolent and religious institutions of the country.
It is by it your railroads are built, your banks established,
your laws are made and maintained ; and the very govern-
ment under which you live is but the result of associated
effort : it is the lever of Archimedes by which our o^vn in-
jured but humane and beloved profession is to be elevated."

These are forceful and vigorous words of Dr. Thomas, and
it may well be questioned if in the various and sundry dis-
sertations, lectures, etc.. the profession has listened to of late
years on this vital topic of medical organization there have
been uttered more trenchant and eloquent phrases.

The State Society with such magnificent leadership con-

X. C. MEDICAL SOCIETY. 263

tinned to prosper greatly, and at the session of 1860 forty
Comity Medical Societies were represented and a maximum
of membership reached ; but the blighting influence of fratri-
cidal strife and the horrors of internecine war swept over our
fair Southland and it was as late as the year 1881 ere the
State Medical Society had as large an enrollment of mem-
bers as it had in 1861. And I may add its percentage of
enrollment of the active practitioners from among the ranks
of the graduated physicians of the State was actually greater
in 1861 than it was in any year afterwards until 1904, or
one year after our reorganization at Hot Springs.

Dr. Alman Holmes, of Clinton, IST. C, reported an ovari-
otomy done in 1858.

Dr. Chas. E. Johnson, of Raleigh, in 1869, published his
treatise on "Insanity and its Medico-legal Relations," dedi-
cating it to "the members of the Medical Society of the State
of Xorth Carolina as a slight testimonial of respect for the
talents and patriotism which induced you, 'a. gallant few,' to
step forward in the Avbrk of medical reform in North Caro-
lina ; of esteem for those steadfast virtues, courage and in-
dustry which caused you to press forward amid the greatest
discouragements, and almost defeat, in fact, to perform the
tasks of hope in the midst of despair, and of acknowledg-
ments of disinterested friendship and for honors conferred."

In 1872 a committee of the Society formulated the basic
principles of the State Pharmacy Law as related to the sale
of poisons, and later secured its enactment by the Legislature.

Since the adoption of the Constitution in 1849 the Society
has revised its organic laws at various times. In 1850, 1853.
1854, 1868, 1880, 1888, 1891 and in 1893. In the latter
year mention of the County Societies was left out, and mem-
bers were elected direct by the State Society without being
members of or connected in any way with County Societies.
All reference to Delegates from County Societies was omitted
in the revision of 1893.

In 1903 the present Constitution, fashioned after the old

264 FliTY-PIFTH A2v"2^CAL SESSION

original Constitution of 1849, with County Societies as its
basis and in harmony with the recommendations of the xlmeri-
can Medical Association, was submitted to the Society at the
Hot Springs session by a committee of Drs. J. Howell Way,
Jas. A. Burroughs, M. H. Fletcher, Geo. W. Pressly and H.
A. Royster, and after a free discussion unanimously adopteoh
Most of the revisions have been limited to minor matters,
only three vitally different Constitutions having been in ex-
istence since the formation of the State Society in 1849 —
those of 1849, 1893 and 1903. And 1 may add those of 1849
and 1903 are very similar in both design and purpose, each
being based upon County Societies; only the latter dividing
the Society for good and sufficient reasons into two bodies, a
business and a scientific section.

The State Board of Medical Examinees.

The idea of having a State Examining Board of Licensure
for physicians took deep root at an early period in the history
of our Society, and for several sessions unsuccessful efforts
were made to induce the Legislature to enact such a measure,
but without results, until February, 1859, when practically
the present medical practice act was made a statute of Xortli
Carolina. The penalty clause was added in 1885, and the
registration clause in 1888. In the original law the board
met annually on the first Monday of May, alternating each
year between Morganton and Raleigh. The privilege of elect-
ing the Board of Examiners was vested in the Medical So-
ciety of the State of ]^orth Carolina, as at present, but an
added clause read "except when the Legislature chooses to
exercise this right." At the Society meeting in 1869 a com-
mittee was appointed to petition the Legislature to allow the
''Board of Examiners to meet at the same time and place as
the State Medical Society," which request was made the law.

At first a full boar<l of seven members was elected for a
term of six years, and at each of the five succeeding sextennial
periods a full board was elected for the term of six years each

N. C. MEDICAL SOCIETY. 265

imtil iu 1S90, when it was deemed advisable not to elect an
entirely new board at each election, and three were elected for
six years, two for four and two for two years, respectively.
Very soon the Society again experienced a change of mind
relative to this and decided to return to the full term of six
years for each member of the board, and as rapidly as it could
be worked out without changing the terms of the incumbents
the former method was restored, and in 1902 a full board
of seven was elected for six years, whose official terms all
expire at this session. This necessitates an election at this
session of a new State Board of Medical Examiners, a respon-
sibility I am sure the Society will discharge in the General
Meeting on the second day of the session with fidelity to it-
self and due regard to the vital interests entrusted to its care.
In this connection I digress a moment to remind you that
the cases of the State v. McKnight and the State v. Biggs yet
remain matters of record in our Supreme Court decisions,
unreversed ; and in addition thereto rests undisturbed upon
our statute books, the iniquitous medical sectarian legislation
enacted during the session of the Legislature of 1906-7,
whereby the entering wedge for the disintegration of our med-
ical license laws was made in the creation of a special Board
of Examiners for a certain sect of practitioners. There is
absolutely no more excuse or reason for the existence in i^orth
Carolina of a special Board of Medical Examiners, to examine
and to certify to the professional capacity of medical prac-
titioners of electro-therapy, or hydro-therapy, or rhinology, or
opthalmolog^% or any other special method or theory of prac-
tice, than there exists the necessity of a special examination
before the Supreme Court of attorneys applying for State
license, upon particular methods of professional procedure in
practice about which even the best lawyers may have diverging
views, in land titles and conveyancing, or railway practice,
or criminal procedures. Hence I must say I deem it the duty
of every high-minded practitioner of medicine in our State
to feel there vet exists a stigma on the science of medicine in

266 FIFTY-riFTH ANNUAL SESSION

North Carolina, irremovable, until the last vestige of sec-
tarian medical practice legislative enactment is erased from
onr statute books, and all individuals essaying the practice of
the healing of sick men and ^vomen and children are required
to stand the same examination upon the formation, nature,
character and diseases of the human machine they propose to
treat when its physiologic function is disturbed. Minor differ-
ences of method in practice or theory of the same are imma-
terial, and should never have been permitted serious consider-
ation by the law-makers, and the fact that such legislation
was ever enacted for the benefit of less than a couple of dozen
practitioners, constitutes a monumental disgrace to our alert-
ness, and affords a most striking illustration of how easy it is
to secure ordinarily special legislation if onl}^ active and in-
sistent.

From this experience we should take warning and in future
years have the profession in the County Societies fully and
early advised of all such improper attempts at medical legis-
lation in order that they may have the opportunity to exert
the proper influence upon their home members of the legis-
lative body.

Pkeliminary Education fok Medical Students.

This vital subject has engaged the attention of this Society
for more than fifty years, and is still in an unsatisfactory
condition, but we should institute active efforts to secure its
early and correct adjustment at the hands of the next session
of the State Legislature. With a medical college course of
four years professional training, and the added fifth year of
l>ractical hospital work, which more than a third of the recent
medical graduates are securing ere they begin practice, the
lamentable fact yet remains that from twenty to thirty per
cent of all applicants for State license in North Carolina fail
in their examinations, and the percentage of rejections re-
mains as high as it was fifteen and twenty years ago. That
our excellent board is rejecting more applicants than it should

N. C. MEDICAL SOCIETY. 267

properly do I do not for one single moment believe. Always
the personnel of this board is high and its members actuated
by conscientious purpose to perform its laborious duties for
the best interests of the public. But there is something radi-
cally wrong in that the percentage of rejections continue so
high ; and an experience of several years as a member of that
body, participation in the examination of some hundreds of
young physicians, a critical study of the records of the board
from 1859 to date, coupled with observations of similar work
in other States, convince me that our State Board of Medical
Examiners is only doing its duty in rejecting so large a per-
centage, and that the remedy is not in their hands but in ours
to secure at the hands of the Legislature added enactments
prescribing a standard of entrance requirements for students
of medicine matriculating in the medical colleges of this State.
and also apply it to all physicians applying for examination
for State license in ISTorth Carolina. The adoption by our
law-makers of such measures would immediately serve notice
upon the young men of this and other States that they must
fit themselves to begin the study of medicine before doing so,
else they will have difficulty in securing license to practice.
Of course efforts to secure such added legislation would en-
counter the usual pleas of consideration for the young man
of limited means, etc., but I am convinced that a careful study
of the experiences of our board with educated and poorly pre-
pared applicants, and a proper appeal to the intelligence of
our legislators, would result in the needful addition to our
statutes, thus adding the crowning complement to the statute
of 1859. I commend to your careful consideration this mat-
ter, and suggest a careful rereading of the President's address
to this bodv in 1906, in which address the subject was most
intelligently discussed.

OuK Relatioxs to the American Medical Association
AND Its Journal.
Receiving from the great ISTational Medical Association, as
it appears Xorth Carolina physicians did receive, the impetus

268 FIFTY-FIFTH A:!^NUAL SESSION

leading to organization of the State Medical Society in the
few years following the promulgation of the Code of Ethics,
it was most natural that our State Society should have felt
kindly inclined to the A. M. A., and it is very evident from
an examination of our early records that up to the time of
the War of Secession the relations between the two organiza-
tions and their members were most cordial and sympathetic.

In the post-bellum period there was a disinclination on the
part of our State Society leaders, or apparently such was the
case, to have much to do with the affairs of the jSTational Asso-
ciation. I may be permitted to observe that I have thought
there was still in existence a bit of this same sentiment,
though not so strong and assertive as formerly. Meanwhile
the A. M. A. leaders have manifested a pleasingly truly na-
tional spirit, each of our sister States, Virginia and Tennessee,
have had its presidency within the past three decades, while
its honors and its opportunities (wath the single exception of
the Vice-Presidency, which most worthily fell upon the great
O'Hagan a few years before his death — and Tennessee has
had that again since then) have gone to other States whose
profession possessed no greater ability than ours, but whose
leaders were more in sympathy with the work of the National
Association.

When we fully realize the truly great and beneficent labors
for the elevation of professional work and standards along
so many different lines in which our great American Medical
Association is at the present time very properly engaged, our
attitude can but be one of sympathy and support, for who
can better or so well do this work than the properly accredited
representatives of the great organized national medical pro-
fession ? And it affords me much pleasure to here record the
fact, as such I believe it to be, that the very great majority
of the reading, thinking members of our profession in this
State are in hearty sympathy and cordial accord with the
numerous lines of advanced professional effort now engaging
tlie attention of the leaders of this gi'eat ISTational Associa-
tion.

N. C. MEDICAL SOCIETY. 269

While only a decade past there were scarce two-score of
physicians in our State who were members of the A. ]\I. A.,
and they were in the main residents of a certain section of the
State, it is suggestive of another milestone of progress passed
to note that the present membership of the ISTational Associa-
tion in Xorth Carolina is almost actually equal to the entire
membership of the State Society six years ago. And its 'great
weekly journal, one of the most ably conducted and admittedly
the most widely circulated and read of any medical journal
on the face of the earth, is found paying its weekly visits to
the offices of almost one-half of the members of this State
Society. This is as it should be, for, while there will always
be an appropriate and a fertile field for the privately owned
medical journal, the necessities of the times imperatively de-
mand that an organized national profession shall keep certain
matters of concern before the guild and conduct certain lines
of general work for the profession at large, and in the proper
development of these things a great national medical magazine
published at frequent intervals is a necessity. Differing as
I may and have done at times with the policy of the present
management of the journal of the A. M. A., I must in simple
justice to all concerned say the American Medical Associa-
tion and its great journal is successfully accomplishing things
for the betterment of the profession and the people of Amer-
ica— and things which without a great organization like it
could never by any possible means be done — and it merits
and should receive the earnest support and practical assist-
ance of every member of our profession in this State.

Medical Journalism in j^oeth Carolina.
From the organization of our State Society in 1849 to date
our Annual Transactions have been issued in one annual vol-
ume. At first this was only a modest pamphlet of a few
]iages ; later it evolved into a stout volume with paper covers ;
still later it assumed the dignity of a well-bound volume, and
in later years the prolificity of our membership had necessi-
tated the issuing of a portly and massive octavo. This

270 FIFTY-PIFTH ANNUAL SESSION

method of publication of our Transactions can, it is very
doubtful, ever be imjDroved upon. Certainly a neatly bound
volume is cared for more and preserved with far greater cer-
tainty than would monthly issues of a State journal of medi-
cine issued by our Society, and I have but to commend the
w^isdom of our Society in adhering to our original plan of
publication rather than embarking on the dubious experiment
of attempting to run a State medical journal, as is being done
with more or less success by several of our sister State So-
cieties. A glance at the progress of medical journalism in
North Carolina is of interest in this connection.

In 1856, just seven years after the organization of the
State Medical Society, an agitation began in the membership
for the establishing of a iSTorth Carolina Medical Journal,
which could also print the transactions of the Society in its
pages, and 125 subscriptions were obtained. The whole mat-
ter was referred to Dr. Will George Thomas for report to the
session of 1858. At the same time Dr. Edward Warren was
elected editor in the event sufficient subscribers were pledged
to sustain the undertaking. In 1858 Dr. Warren reported
the securing of 300 subscriptions, but still lacking at least
100 regarded as essential to success, he advised against un-
dertaking the publication and tendered his resignation as edi-
tor. After considerable discussion Dr. Warren was continued
as editor, and the Society pledged its financial support to the
extent of defraying the necessary expense of the North Caro-
lina Medical Journal, which was thus launched upon its
career of future usefulness and helpfulness to the Society
and the profession in this State especially. In 1860 Dr. W^ar-
ren was succeeded as editor by Dr. Chas E. Johnson, of Ea-
leigh, who with Dr. S. S. Satchwell, of ISTew Hanover, con-
ducted the Journal until ]!^ovember, 1861, when its issue
ceased. After the spring meeting of 1861 the State Medical
Society did not meet again until June 6, 1866, at which time
it was advised of "the entire loss of the books, accounts and
other equipments of the Journal during the occupancy of

ISr. C. MEDICAL SOCIETY. 271

Raleigh by the Federal troops." It promptly levied, an as-
sessment of $-i on each member to pay the debts of the Journal
and recommended its revival. The following year the assess-
ment was placed at $3, but it ^vas several years ere the entire
''war debt" of the Journal was paid. In the meantime the
State Society continued, as it has wisely on to the present
day, the admirable system of issuing an annual volume of
Transactions more certain of preservation and ready of ref-
erence.

In 1877 Dr. Thos. F. Wood, of Wilming-ton, with Dr. ]\I. J.
DeRossett, revived the North Carolina Medical Journal as a
private enterprise, and while conducting it from then until
the time of his death, the Journal was never again the prop-
erty or the liability of the State Society, whose only active
interest in it was a vote of confidence making it the Society's
''official organ," and wishing its distinguished editor everv
success. Dr. Thomas Fanning Wood was one of the greatest
physicians Xorth Carolina or the nation has ever produced —
a man of rare and varied attainments, an incessant worker
and an indefatigable investigator, a learned botanist, a scien-
tific pathologist, a skilled practitioner of medicine gi'eatly be-
loved by his clientele, a wise and efficient organizer of men
and things, a talented and versatile writer, and with all these
accomplishments he was, best of all, a most accomplished and
lovable Christian gentleman without taint of cant or hypocrisy
in his thought, word or deed.

Under his able editorship the North Carolina Medical
Journal soon became an established institution of medicine
in Xorth Carolina, and I do not exaggerate when I say its
helpful influence extended beyond the confines of the State
and of the nation alike, and its brilliant and lovable editor
became favorably known in every clime where English peri-
odicals were read. Its book reviews were of rare and notable
excellence, surpassing in thoroughness of analytic conception
and critical review those of every otlier English speaking
State or nation except two, the British Medical Journal and

272 FIFTY-FIFTH ANNUAL SESSION

the old Americcui Journal of the Medical Sciences. For a
number of years prior to his death in 1892 Dr. Wood enjoyed
the valuable editorial assistance in the work of the Journal
of Dr. Geo. G. Thomas, who contributed greatly to enhance
the usefulness and success of the periodical. Subsequent to
Dr. Wood's death in 1802 the Journal came inider the edi-
torial control of Drs. J. Allison Hodges and Robt. D. Jewett,
who successfully managed its affairs until its removal to
Charlotte several years ago, since which time it was conducted
by a staff with Drs. W. H. Wakefield, J. D. Eoberts, H. A.
Roj'ster and W. O. ISTesbit, editors. In 1901 the relationship
of the North Carolina Medical Journcd to the State Medical
Journal as '^the official organ" was, by vote of the Society,
abolished. In 1908 it merged its identity into that of the
Charlotte Medical Journal, and the two journals are now
published and known as the Charlotte Medical Journal. In
1892 Drs. Edward C. Register and John C. Montgomery, of
Charlotte, began the publication of the Charlotte Medical
Journal, Dr. Montgomery retiring some ten years later. Start-
ing out the Journal essayed the task of not only being a first-
class Is'orth Carolina State Medical Society journal, giving
much consideration to the special affairs of the profession
in this State, but aspiring as well to become the leading ex-
ponent of Southern medical literature. A comparison of the
make-up of the various journals of the Southland, with a look
into the American ISTewspaper Directory, will at once satisfy
the curious that both ambitions have been accomplished by
its talented editor. A strong and influential leader of the
profession in his city and State, it has been the pleasure of
this Society to honor him at various times and in divers ways ;
he has never sought for his Journal the endorsement of the
Society as ''its official organ," or other adoption at our hands ;
hence it is pleasant to here note that its columns and its edi-
torial pages have alike, at all times in devotion to the interests
of this Society, rivaled that of any of the state society-owned
journals; and this friendly assistance and support has been

N. C. MEDICAL, SOCIETY. 273

freely accorded without price or Society financial liability
upon our part. During the present year the merging of the
old North Carolina Medical Journal in the Charlotte Medical
Journal, with the added interest and energy of the older pub-
lication, we have the satisfaction of knowing our State is
leading the Southland in the realm of medical journalism.

The State Board of Health.

Like the State Board of Medical Examiners the North
Carolina State Board of Health is the legitimate child of this
Society, and as such well deserving of the fullest support and
consideration at our hands at all times. For several years
• prior to 1877 the Society discussed the advisability of secur-
ing legislation establishing a State Board of Health, but the
Legislature declined to enact the needful statute or make the
all-requisite appropriation. In that j^ear, however, the efforts
of the Society's committee succeeded and the Legislature of
1877 made an appropriation of one hundred dollars for the
use of the board, and authorized the State Medical Society
to assume the functions of a State Board of Health for North
Carolina. This duty the Society prepared to discharge by
electing a board at the session of 1877 w^hich was promptly
organized by the election of Dr. S. S. Satchwell, President,
and Dr. Thos. F. Wood, Secretary and Executive Officer. Two
years later the Legislature decided to have the Governor select
a portion of the State Board of Health, and this bipartite re-
sponsibility has continued to be discharged conjointly by the
Governor and the Society in harmony.

The appropriations have been increased from time to time,
and while not as yet sufficiently large to enable the board to
accomplish the work desirable to be done, yet it is very doubt-
ful if the State of North Carolina receives so large returns in
practical value for any of its money appropriations as accrue
from the work of the State Board of Health. At the same
time, w^hile felicitating ourselves upon what has been done, it
is emphatically advisable and our professional duty as well.

274 FIFTY-FIFTH ANNUAL SESSION

to bear in mind that mncli more woi'k is needed in this State
by the Board of Health and along other lines of effort before
the opportunities afforded ns to help promote the public
health will be met as completely as the knowledge of modern
medicine enables us to go, or as fully as other States are
w^orking on lines of public health just now. Take as a single
illustration the monthly "Bulletin" of the State Board of
Health. An enlightened legislative conscience should promptly
provide means to enable it to be developed into a popular
journal which would seek to educate both doctors and public
in the principles and practice of modern public and private
hygiene. It should have a wide circulation and contain ar-
ticles on popular scientiiic medicine, v/hich would serve the
useful puqDose of affording our people the opportunity of se-
curing some knowledge of real modern medical science, thus
serving to effectually antidote the vagaries and inaccuracies
not to mention the downright and palpable untruths circulated
among the laity through the newspapers, through pseudo-
scientific magazine articles the "patent medicine'' almanacs,
et id genus omne. If the Department of Agriculture issues
periodical information relative to the plant and animal dis-
eases, why not a Department of Health, supplied with ample
funds to do at least as much for the betterment of the human
body ?

On other lines we ne^d work, and we need money to do it
with. The sister States on either side of us are appropriating
public funds with much more liberality to the development
of their State Boards of Health work ; and, gentlemen, I point
it to you as one of your professional publicist duties to culti-
vate a public sentiment which will demand such action at the
hands of our legislators even though the levy for State pur-
poses should exceed forty-three cents! Respect and reverence
for the memory of a great and good man, Dr. Thos. F. Wood,
will not permit my passing from the consideration of the
work of the State Board of Health and our relation thereto,
without referring to the fact that from its first inception until

iSr. C. MEDICAL SOCIETY. Z k O

the dav of his death in 1S92, he continued its active, zealous
working Secretary, building something where nothing had
been before, and leaving us the heritage of a rich example
fruitful with great accomplishment. His mantle fell on most
worthy shoulders in the person of our present estimable Sec-
retary, Dr. Lewis, who has for fifteen years past been build-
ing on the foundations so well laid by Dr. Wood. But it is
well for us all to bear in mind the fact that as yet the actual
work of our State Board of Health as related to the magnitude
of the problems before it, is but merely begim, and its suc-
cessful development and realization hold many problems for
the future to solve, and in their adjustment the membership
of this Society will naturally exercise most vital parts.

HoNOEAKY Members a:n^d Honokary Fellows.

I would respectfully call your attention to the fact that
while our Constitution provides for Honorary Members and
Honorary Fellows, that none have been elected for a number
of years past. The list of Honorary Fellows, which stood
at twenty-one, the maximum of attainment during our his-
tory, some ten years ago, has had no additions made to it.
while deaths have reduced it to fifteen members. Certainly
this list, which is composed of members of the Society "who
have been members of this Society continuously for thirty
years, and whose dues have been paid during that time,"
should be added to at this session and their names appear at
the proper place upon our "roll of honor" in the forthcoming
volume of Transactions.

The attention of the House of Delegates is invited to this
matter of simple justice to those who have borne the burden
and heat of the day for the score and a half of years past,
and whose general standing and professional attainments war-
rant this vote of confidence and esteem by this Society.

Deaths Durixg the Year Past.
Since the annual meeting of this Society at Morehead Citv
in June, 1907, twenty-three members of the component

276 FIFTY-PIFTH ANNUAL SESSION

Couutj Societies of this body have completed their earthly
course and passed into the presence of the Great Physician
above. Our Obituary Committee will during the session
render fitting report thereon. In our necrological list for the
year will be found the names of three distinguished formei
Presidents of the State Society.

Dr. Joseph Graham, of Charlotte, was a member of the
State Board of Medical Examiners from 1878 to 1884, and
presided over this Society at the thirty-third session, held in
ISTew Bern in 1886. He was most highly regarded in the
city of his life-work, as well as throughout the State, and
appreciated as a wise and learned physician as well as a use-
ful and patriotic citizen.

Dr. Thomas D. Haigh, of Fayetteville, was a confrere of
Dr. Joseph Graham's on the State Examining Board, serving
alike with him the six-year term from 1878 to 1884. Dr.
Haigh was elected President of the Society at the Charlotte
meeting in 1887 and presided at the session in Fayetteville
the following year. A handsome, scholarly gentleman pos-
sessing a cultured mind and thoroughly grounded in the prin-
ciples of his chosen profession the success that came to him
was but his merited reward.

Dr. Patrick Livingston Murphy, of Morganton, served
the State and the profession as a member of the Board of
Medical Examiners from 1884 to 1890, and at the Winston-
Salem meeting of the Society in 1896 was honored with the
Presidency of the organized medical profession of his State,
occupying the chair at the Morehead City session in 1897.
But his great life's work by which his name will be best re-
membered in North Carolina during the generations to come,
was his successful labors in caring for the mental unfortunates
of this State during the quarter-century of his incumbency
of the Superintendency of the State Hospital for the Insane
at Morganton ; a record of which every citizen as well as phy-
sician of this State is justly proud, and one which will re-
main a permanent part of the State's history so long as the

]S'. C. MEDICAL SOCIETY. Z < i

duty of the strong helping the weak is a tenet of our civiliza-
tion.

It was my good fortune to know personally each of these
three eminent Carolina gentlemen and physicians, and re-
viewing at this date their professional careers I am most pro-
foundly impressed with the great love and genuine heartfelt
affection each of them bore this Society, and the confidence
they cherished in its influence and work in the upbuilding
of professional characters and standards in North Carolina.
Regular attendants upon its annual meetings, active and in-
terested participants in its every work, firm believers in the
exalting and ennobling influences emanating from profes-
sional contact, faithful exponents of the best in our art, their
labors are ended and their records on earth completed. In the
coming years no history of North Carolina men of medicine
will be complete without the names of Graham and Haigh and
Murphy. Immediately following the notice of the death of
each of these distinguished physicians I communicated with
their respective families and agreeably to them arranged for
the preparation of a suitable memorial of each, which wiU be
presented to you during the session.

In conclusion, permit me to express my thanks for tli*
kindly patience you have exercised in listening to these ran-
dom observations of mine relative to the Society, whose every
interest is dear to every one of us. She needs no encomium
at my hands, no praise or eulogy from yours ; but service,
work, enthusiasm in the cause of scientific medicine, faithful
and loving devotion to higher ideals and loftier conceptions
of the true physician's life — these are demanded of each of
us. These we must exemplify in our lives if we are to prove
worthy successors of the noble men of the past whom I have
referred to here to-day. And these sacrificial offerings we
shall bring to the altar of the grand old Medical Society of
the State of North Carolina in fond anticipation of exalting
her ideals and her standards as the years pass on. I thank
vou 2:entlemen, I thank you.

278 FIFTY-FIFTH ANNUAL SESSION

The Annual Oration

THE PHYSICIAN ANB EDUCATION.

BY CHARLES S. MANGUM, UNIVERSITY OF NORTH CAROLINA,
CHAPEL HILL, N. C.

The doctor's degree is bestowed by institutions of learning
in recognition of the highest attainment in some special line
of endeavor. The one receiving such a degree assumes with
it an obligation to maintain a certain standard of excellence
so that nothing he may do or may leave undone shall tend to
cheapen this badge of his efficiency. Each man's life, when
his work is done, will show in what manner he has lived up to
this obligation ; and it rests entirely with those who bear the
degree of doctor of medicine to command respect for and con-
fidence in their title among intelligent, thinking people.

In the past the obligation has been more than fulfilled, as
the names of a host of the world's most famous men will tes-
tify ; for the medical man of history, by his wonderful achieve-
ments and unselfish devotion to duty, has made of the title he
bore a badge of honor. The responsibility for the present
and the future is upon our shoulders.

Some of us are ripe in years and already crowned with
honors; some are bearing the brunt of the day's w^ork; while
others look forward with all the enthusiasm of youth to the
opportunities of the future ; but all must wait for the judges
of to-morrow to place us in a niche of fame or upon the long
roll of those who have tried and failed.

If w^e are to live up to our heritage and retain the position
of preeminence won by our predecessors, it behooves each one
of us to do his full duty and strive for lofty ideals of service
and true manhood, whether our sphere of action be great or
small ; for the life-work of the lonely physician, isolated from
all of his kind, is just as noble and often as far-reaching in

X. C. MEDICAL SOCIETY.

279

results as that of his more fortunate brother, who dwells in
an atmosphere of medical research and in constant touch with
master minds. Though we work as individuals, we should
never lose sight of the fact that our actions make for the honor
or the discredit of the profession to which w'e belong. We
have been trained to solve the problems and to do the work of
the present, and the body of men before me is evidence that
the work will be well done.

But the young men and women who are to fill our medical
schools during the next few years will take up our tasks where
we leave them, and upon their shoulders will rest the respon-
sibility w^hich now belongs to us. The problems they will
have to face and the remedial agents they will have at their
connnand are beyond the g-ift of man to foretell. It is our
plain duty to see that they are prepared to assume this re-
sponsibility. Man's insistence that nature give up her secrets
is becoming gTeater with every year, and as thought and re-
search add to the sum of human knowledge the medical pro-
fession must keep pace, for the sick man will always insist
ui>on his right to receive the benefit of whatever will prolong
life or relieve suffering.

Xo one's daily vocation takes him through so wide a range
of liuman knowledge and experience as the doctor's. It is
difficult to conceive of any knowdedge that he can not turn to
practical account. The curriculum of the modern medical
college covers almost the entire field of science, with the ex-
ception perhaps of geology and astronomy, and who would
dare say how long these two may remain unattached.

The eifort to meet the demands of scientific progTcss has
caused us to forget and to neglect one of the fundamental
principles of education, which is ''progression/' The out-
come is a condition of affairs in which the student finds him-
self helplessly wandering in a labyrinth of tasks, for which
all too little time is allowed, and which he must undertake
without previous training sufficient to develop the manual
dexterity and the power of scientific reasoning which are
necessary for their accomplishment.

280 FIFTY-FIFTH ANNUAL, SESSION

If a teacher of matbcmatics were to take a pupil from a
class in arithmetic and require him to master the calculus, one
could hardly expect the pupil to distinguish himself ; and yet
this well illustrates the conditions in many of our medical
schools.

The consequence is that even the brighcst men are apt to
acquire a mere smattering of many sciences, but a deep and
abiding knowledge of none; while many a man who might
have become an honor to his profession is overwhelmed with
discouragement and gives up the hoj^eless task.

We can not stop. We can not be content with what we are
or what we have been, great and glorious though this may be.
The progress of events is not in our hands to control. The
very nature of our mission forces us, whether we will or not,
to the very forefront of scientific achievement. If we are to
fulfill this mission in the future as we have in the past, it is
incumbent upon us to see that those whose preceptors we are
shall receive such training as may fit them for the work of
the future, so that ''what the father found glass and made
crystal, the son may find crystal and make pearl."

The greatest weakness in the present system of medical
education may be found at its beginning. Students, whose
training has in no way fitted them for the courses prescribed
for them, are permitted to begin the study of medicine, only to
realize when too late the immense advantages of which they
have been deprived. And it is our fault, for they are in ig-
norance of what is before them, while we know.

The day has passed when the mere collection of a mass of
facts may be considered a medical education. The intelligent
patient demands that the physician shall be able to reason,
and that he shall be trained to think logically and to reach ac-
curate decisions before he is granted his license, and not leave
too much to be learned through "experience." The patient
and long-suffering public is beginning to rebel at the conse-
quences involved in its share of this "experience" — so valu-
able to the young practitioner.

TS". C. MEDICAL SOCIETY. 281

The American Association of Medical Colleges, realizing
the present weakness and foreseeing the future needs of the
jDrofession, has sent out a call to all medical schools to take a
step forward in the elevation of the standards of medical edu-
cation, and require of their matriculates such previous train-
ing as may enable them to pursue their studies with a greater
degree of thoroughness and some hope of larger results.

This is no young man's movement, but one inaugurated
and led by the oldest, wisest and most experienced thinkers
in the profession. From all over the land the schools, and
among them those of Xorth Carolina, have responded to the
call, and now they look to the profession, whose servants they
are, to uphold and approve, for no public health movement
in a State can be of greater importance than that directed to-
ward securing high standard medical men. The public de-
mands of the doctor that he repair the maimed body and pre-
vent or cure disease and our teaching, our thoughts, our coun-
cils all center upon this paramount duty.

But the mission of the doctor goes further. One of our
great teachers has said that "a physician may possess the
science of Harvey and the art of Sydenham, and yet there
may be lacking in him those finer qualities of heart and head
which count for so much in life." Unless a physician realizes
that his patient is not a mere pathological problem, but a
fellow-mortal, endowed with all of human nature's weakness
and frailty, and can judge with charity and temper his min-
istrations with something of human kindness and sympathy,
he misses what is highest in his calling and becomes a mere
mechanical device to be catalogued and called upon only Avhen
unavoidably necessary. The old family physician, who may
within a few years, if the present regime continues, be known
only as a character in story or legend, owes his position of
trust and affection less to his professional skill than to his
qualities of heart and head, which make him both counselor
and friend.

The modern student of medicine, working with science, in

282 FIFTY-FIFTH ANNUAL SESSION

science, for science, is in danger of becoming callous to all
feeling of sympathy nntil he comes to look upon poor hnmau
flesh as a mere adjimct to the laboratory, a never-failing
field for fresh problems, and without the findings of the post-
mortem the solution of the problem is never complete and the
requirements of science remain unsatisfied.

Let us hope that it may never become unscientific to get
well. As we mould the growing mind, or labor to increase
our own efficiency, we should never lose sight of the ethical
and the humane, but strive for knowledge, not only of disease
and its cause, but of ourselves.

The physician's interest in education is not limited to the
making of medical men, for ignorant obstinacy and supersti-
tion are more powerful enemies even than the diseases he com-
bats. Without an intelligent public, realizing and appreci-
ating the value of health laws, the doctor is handicapped in
his work and his best efforts often rendered futile. The law-
makers have realized this and have required that the school
children shall be taught the principles of physiology and hy-
giene. The school-teachers of the State, with a devotion to
duty so characteristic of their calling as not even to excite
comment, have undertaken the task, but few of them have had
opportunities to fit themselves for the work, and hence the
results have not been satisfactory. Every physician should be
a teacher in his own community. Give to your school-teachers
who have in their immediate care the training of the children
the advantage of your practical knowledge of physiology, in-
fectious diseases, and the laws of hygiene and quarantine,
and you may safely leave the rest to them. We will have
in another generation a citizenship that will be an ally and not
a hindrance to the health officer, and will do more to elevate
the standards of public health in our State than all the laws
ever pass<:'d.

K'orth Carolina possesses a State Board of Health which
is both energetic and efficient. Through their efforts a great
deal of helpful legislation has been enacted, and through their

X. C. MEDICAL SOCIETY. 283

publications and their personal teaching the people have been
put in possession of much useful and practical knowledge.
But Xorth Carolina's unofficial board of health should com-
prise every man or woman who possesses a license to practice
medicine, and not luitil this is so can the wise plans of our
leaders bear full fruit. Health laws are not unifoi'mly en-
forced, nor can they ever be until the people are taught simple
medical common sense, and the responsibility for this rests
upon the individual members of the medical profession.

Xow, Gentlemen of the Medical Society of the State of
!N"orth Carolina, let us go back to take up again the dav's
work, fully resolved to be true to our heritage and give to our
children something better and higher and nobler than we our-
selves have received, and by thus adding to the sum of human
happiness build for ourselves monuments of living stones.

284 FIFTY-PIFTH ANNUAL SESSION

The Annual Essay

THE LIISTES OF PROGRESS IK THE PRACTICE OF
MEDICINE.

BY DE. THOS. R. LITTLE, GREENSBORO, N. C.

On the title page of a certain treatise on the "Practice of

Medicine" are to be found these significant words :

"Is an arch, where through gleams that untraveled country whose
margin fades forever and forever as we move."

To every one who has with some sort of conscience set him-
self to learn something of the art's vast evasiveness, it must
often appear that its hither margin fades with a rapidity' out
of all proportion to his most eager movement in pursuit ; yet
the faithful investigator is not "following a wandering fire,"
nor grasping at a mere bauble which will turn to "dust and
ashes in his hand."

By no means an exact science, and not destined to become
such, for this very reason the field of medical research holds
out to the scientist promise of such reward as is not to be
attained by investigation along the lines of a fixed and un-
changing science.

Looking back from our present advanced position upon
the state of medical knowledge a hundred years ago, we can
but feel that most of our predecessors of that and earlier
days must have considered their art to have reached the
zenith of its development.

For centuries there had been practically no advance in
curative medicine. Since that time the rate of progress has
been so rapid and changes in method so numerous and pro-
found that of the therapeutic structure of that day there is
scarce left one stone upon another. Gathering momentum
as it came, the forward movement, nevertheless, had not yet
attained its full force until some twenty years ago. Since

X. C. MEDICAL, SOCIETY. 2S5

that time it has been truly said that there has been more real
progress in the practice of medicine than there had been in
the twenty centuries immediately preceding. The same state-
ment is literally true of the special domain of surgery.

It is true that during the ''dark ages" of medicine, great
men of splendid intellect had arisen from time to time in the
medical profession, and in many instances showed a prescience
nothing short of marvelous in near approach to solution of
problems which puzzled all their successors until the white
light of our day penetrated their inmost recesses, demon-
strating at one and the same time the vast possibilities of
present day science and the wonderful acuity of our fathers.
Still, largely through lack of those external aids and ap-
pliances which other sciences have given us in recent years,
they fell short of complete attainment and so failed to give
to the world discoveries which, when finally evolved, gave to
the practice of medicine a new meaning and made desert
places to rejoice.

In the very dawn of medical practice as we know it, the
master, Hippocrates, established a method which, although
sometimes discarded by those who followed, and almost lost
sight of in the effort to found systems based on other theories,
is to-day the rock bed of learning for those w^ho would know
the inmost truths of the healing art. His simple doctrine of
critical observation combined with common sense, and deduc-
tions therefrom, lives to-day and grows steadily stronger, al-
though his humoral pathology has finally passed away — not,
however, until it had held sway well-nigh two thousand years.

Until the time of Jenner's immortal discovery, the medical
mind of the world had studied and worked and delved, eter-
nally possessed by the futile dream of applying to each dis-
ease, each symptom, its specific drug, — groping out into the
darkness toward that longed-for day when, this process being
complete, there should be no more sickness or death. To
what extent success had followed centuries of faithful and
persistent efforts along these lines, Ave need not go far to see.

286 FIFTY-FIFTH ANNUAL SESSION

Two drugs possessing triilv curative qualities for two diseases
they knew and used more than one hundred years ago. This
represents the sum total of results following twenty centuries
of research along the line of curative drug therapy.

In view of this fact, how is it that curative medicine has
made such jjlienomenal strides in the last century and espe-
cially in the last three decades? It is that since the realiza-
tion of the marvelous effects of vaccination against smallpox,
medical scientists have finally aroused themselves from that
dream of a drug Utopia, and have turned their awakened
intellects upon lines of investigation which soon led to results
no less astonishing to their profession than to the world at
large which became the beneficiary of their genius. That
thought germ which finally grew into Edward Jenner's world-
blessed prophylaxis w^as the promise of a new era in the prac-
tice of medicine. The application of his God-given idea is a
simple commonplace to-day ; but conceive if you can what it
meant to evolve de novo such a plan and to carry it to a suc-
cessful issue in the face of such violent passion and prejudice
as has seldom been accorded another of the most beneficent
boons gratuitously bestowed upon man. To appreciate Jen-
ner's situation we may recall that now, after a hundred years
of successful demonstration, vaccination is frequently as-
sailed, and numerous lawsuits resulting from its enforced
practice attest the fact that mankind will not accept even
a Messing except upon their own terms.

It is said that toward the end of the eighteenth century
every tenth person in England bore the badge of smallpox,
while hundreds of thousands had perished in successive epi-
demics of the dread scourge. By a partial and imperfect
application of vaccination the civilized world has been practi-
cally freed from its ravages, and we know it now as a mild
affection, easily controlled. Nevertheless, its continued ex-
istence among us is a reproach to governmental intelligence.
In the entire German Empire, under compulsory vaccination,
during the year 1906 there were but 26 cases of smallpox

N. C. MEDICAL SOCIETY. 287

with five deaths, and these cases, without exception, were in^-
ported from other countries. Great as has been the result of
Jeimer's patient work in its direct benefit, it is trivial com-
pared to the sequences set in motion by this first step toward
modern medicine. For years, it is true, further advance was
apparently slight and insignificant, but the leaven was at
work and finally results appeared which fully compensated
the long period of sterility.

The world was still fighting malaria with one of the two
known specifics, and this disease was being partially re-
strained, but great as was the benefit of quinine to ma-
laria-cursed countries, its effects are poor and inconse-
quential indeed compared to the results of Laveran's discov-
ery of malaria's cause, and the later developments upon this
basis, which will, sooner or later, remove from the world
the necessity for quinine as a specific for that disease. In
the malaria-infected swamps of Italy sanitation has reduced
the mortality of the disease from 15,000 in 1890 to 7,000
in 1906.

Keeping pace witli the campaigTi against malaria, and far
outstripping this in its profound effect on the health, happi-
ness, and, in some regions, the very existence of the human
race, has been the fight against yellow fever. i\.ll are fa-
miliar with Reed's w^ork in emancipating Cuba from the rule
of this tyrant, and many know something of what Colonel
Gorgas has done along the same line for the Panama Canal
Zone, but it is probable that few are aware that, after a year
of work on the Panama Canal, it was apparent that unless
conditions of health there could be radically changed, our
efforts were doomed to the same fate that overtook the French.
It was Dr. Reed who showed the true source of yellow fever,
and sanitation did the rest.

When Lord Lister demonstrated the cause of blood poison,
at one blow striking the shackles from the surgeon's hands
and freeing maternity from its greatest horror, wdiat achieve-
ment of all the drugs of all the ages could be compared wnth

288 FIFTY-FIFTH AX]N"UAL SESSIO:^

that single discovery ? Its ever widening influence has been
incalculable. Imagination fails utterly to grasp the signifi-
cance of that word "Asepsis."

A great American surgeon, lately gone to his glorious re-
ward, has said of these achievements : ''The discovery of the
microbic cause and real nature of inflammation was the fir^t
and greatest triumph of scientific medicine and has contrib-
uted more to the prolongation of human life and mitigation
of suffering than all previous medical knowledge which has
accumulated from the time medicine was first practiced and
taught. It raised surgery from a mechanical art to a science,
and placed the study and practice of medicine on a rational
foundation and unlocked the doors which up to that time
had barred the progress of intelligent and effective sanitation.
The two distinguished figures which have inaugurated this
new and enlightened era in medicine are Pasteur and Lister,
the two men who, to my mind, have conferred a greater
benefit on the human race than any other two mortals in the
history of the world. These two scientists and investigators
have built the foundation for the new temple of scientific
medicine and surgery, in the raising of which enthusiastic
scientists all over the world have taken an active part.

From earliest ages the Great White Plague had extended
unstayed its merciless dominion. Its victims, drugged with
a thousand vaunted "specifics" ; subjected to numerous pro-
cesses of torture under the guise of treatment, still continued
to melt away by tens of thousands, leaving only a rapidly
widening circle of contamination. In 1882 Koch discovered
the tubercle bacillus ; drugs practically disappeared from the
scene. Again prophylaxis was the cry, and such has been
the result that many municipalities can now point to records
approximating that of 'New York, — a decrease of fifty per
cent in mortality from tuberculosis in twenty years. Even
including rural districts, the results of prophylaxis against
this plag-ue are astounding. In 1838 England and Wales
lost from this disease 40 persons per 10,000 population; in

^^, C. MEDICAL SOCIETY, 289

1906, desj^ite great increase in density of population, tlie
figures were 11.5 per 10,000. The mortality in 1906 was
abont equal to the decrease observed in the preceding thirty
years; therefore, gTanted the same rate of decrease, in three
or four decades the disease should disappear.

This progressive diminution can not be relied upon, but,
following Koch's lead, albeit along various lines, scientists
have planned and are carrying on campaigns against this
arch enemy which give greatest promise of ultimate complete
victory. It is worthy of note that none of these methods now
undergoing trial depend for curative value upon drugs. Who
could dwell for a moment upon the achievements of modern
medicine and not think at once of Behring's boon to infancy
and early youth, — the antitoxin treatment of diphtheria ?
So evident are its effects that few remain who refuse it the
exalted place due a remedy which has transformed an erst-
while scourge into a comparatively innocuous ailment.

In like manner results are becoming more and more defi-
nite in the control of tetanus, bubonic plague, cholera and
hydrophobia, — some of which are destined to early extinc-
tion, while others may only be robbed of their terrors.

The field of curative medicine of to-day is so closely asso-
ciated with that of sanitation that their borders frequently
overlap and we pass insensibly from one to the other. Foi
instance, typhoid fever — although a reproach to any civilized
community in that it exists at all — is a striking illustration
of the efiicacy of latter day methods — the combination of the
forces of treatment with those of prevention. While the
single measure of the external application of cold is credited
with a reduction of almost 20 per cent in the mortality of
this disease, a knowledge of its cause and method of dissemi-
nation renders its entire eradication not only possible, but im-
perative, and anything short of this well-nigh criminal. It
has been done in Germany. That typhoid fever remains so
prevalent in the United States is one baneful result of the

290 riFTY-FIFTH ANNUAL SESSION

operation of that principle so deeply impressed upon the
average American citizen, namely, his inalienable right to do
as he pleases.

Besides the results obtained in the control of typhoid
fever, note the situation with regard to the management of
another and most common, widely spread, and terribly fatal
disease — pneumonia. So far, in spite of scores of so-called
specifics which have been advanced from time to time only
to be found wanting and to be discarded in favor of the next
equally futile method or drug, we have no agent by which
the mortality from this disease has been reduced. Year after
year we have listened for hours together to learned discus-
sions of this most fruitful subject of debate ; have heard one
series of cases after another cited to prove the efficacy of this
or that or the other remedy — from Antiphlogistine up — aud
have gone home pondering these things in conjunction with
the fact that the mortality of pneumonia is to-day the same
that it was one hundred years ago. Indeed, one eminent
writer, author of a standard text-book on the practice of
medicine, says in that work: ''It does seem to me that pneu-
monia is a more fatal disease now than when I began prac-
tice thirty years ago." For pneumonia drugs have done
their worst. Let us hope (and there is ground for it), that
the new therapy will eventually find a solution of this prol>
lem, despite the failure, for practical use, of the first venture
in that direction.

The peculiar operation of the present-day therapeutics is
well illustrated in the handling of scarlet fever. Ignorant
of its specific virus and therefore, for the present, unable to
apply a curative serum or prophylactic vaccine, we turn to the
other weapon of latter-day practice and by isolation and disin-
fection we execute a flank movement which proves more
effective than would immediate frontal attack, confining to
narrow limits another deadly disease, while we await confi-
dently expected reinforcements from the laboratories.

N. C. MEDICAL SOCIETY. 291

Of greatest conceiii to the rapidly rising Orient, and appa-
rently of more than academic interest to our western shores,
cholera from time to time raises above the horizon its hor-
rible specter face. More than once it has appeared in our
midst, sending a thrill of horror to our very souls. By a
gigantic crusade against filth, and by faithful persistence in
education of the people, this disease will soon disappear
from the earth. Along with it goes bubonic plague, even at
the sacrifice of the cat's time-honored food.

Although a curative remedy for hydrophobia awaits de^
velopment by some investigator of the future, this disease
also has been stripped of much of its terror by application
of the prophylactic measures first suggested by Pasteur.

The most brilliant research of recent years, resulting as
it has in the nearest approach to the ideal method so far
advanced, is that of Wright, which has given us the op-
sonic theory, fulfilling, theoretically at least, the conditions
of the long-sought panacea. It bears a peculiar resemblance
to the ideal dreamed of by our fathers — a specific remedy for
each disease — but is distinctly modern in that drugs have no
part in its application. May we not hope that along this
line lies the ultima thule of medical practice ?

The call from profession and society at large for some-
thing better than the old way, something by which results
might be achieved, has brought into use a great array of so-
called up-to-date methods of treatment, few of which will
stand the test of time. The vast field of electro-therapeutics,
productive of most wonderful opportunities for the charlatan
in the profession as well as out of it (and so ardently cul-
tivated by these and, we must admit, faithfully studied by
some good men), gives but another proof of the effort to be
rid of impotent drugs.

Hundreds of practicing physicians of to-day who were so
fortunate during their student days as to have access to the
enormous clinical material afforded by the Philadelphia
General Hospital (more familiarly known as ^'Blockley" ) ,

292 FIFTY-FIFTH ANNUAL SESSION

will recall one of the rare curiosities of that institution who,
for perhaps a score of years, served his useful purpose as a
source of knowledge, although himself an imbecile with
never a ray of appreciation of his great service to his fellow-
men or of the humiliation incident to exhibition before un-
grateful students. They called him "Bart" — nothing more.
If other name had been bestowed upon him by a loving
mother, full of tender hope for her new-born babe, the hos-
pital records failed to show it, and finally it came about that
no man knew whence he came. Poor Bart ! Having grown
apace and apparently about to blossom into robust childhood,
a dreadful blight fell upon his fair young life and a mother's
fond ambitions faded at its baneful touch. At 37 years of
age, when he died — or rather when the processes of animal
metabolism ceased to operate within him — he was physically
a misshapen child of four, while mentally he had remained
a blanlv. Horrible, pitiable spectacle ! Yet the saddest
thought was that had he come into the world only a few
years later the new therapeutics would have provided a rem-
edy which would have strengthened those flabby muscles, dis-
sipated that jelly-like fat, torn away the veil from his mind,
and might have given to the world

" Hands that the rod of empire might have swayed,
Or waked to ecstasy the Hving lyre."

Ah! Gray's immortal lines contain no eloquence to voice a

thought so sad.

With the marv^elous results of thyroid therapy has come
another line of modern treatment — that of the internal secre-
tions. Cretinism and myxa?dema have found their antidotes
and the suprarenal glands promise as much for that rare but
hitherto hopeless malady known as Addison's disease. In
this group development has only begun.

So we might point to scores of plans being worked out for
the advancement of curative medicine, some of which may
yet reveal even more startling discoveries than the present
generation has witnessed.

2^. C. MEDICAL SOCIETY. 293

Having found the true causes of many diseases and work-
ing from those to rational cure, medical science has come
upon the problem of removal of the cause — in a word, sani-
tation.

Already we are so familiar with some of the various
phases of this far-reaching agency that we hardly realize to
what extent it has permeated the life of the civilized world.
From the well-known work of our national government both
at home and abroad, down through the State, municipal and
county officials, we find an important function of almost
every executive body is that of advancing the public health,
by prevention of disease. jSTote the care exercised with re-
gard to every detail of the environment of children in public
schools — the air they breathe; the water they drink (and the
cup they drink it from); compulsory vaccination; isolation
of infectious diseases and quarantine against the same ; regu-
lation of light ; careful examination of the eyes of every
pupil and adjustment of glasses where necessary, and so on
indefinitely.

We see it again in the solicitude, voluntary or involuntary,
of employers for the welfare of their employees — impressively
evidenced by the expense incurred in keeping the best of con-
ditions about the operative while at work and, whenever prac-
ticable, at his home as well. The great humanitarian move-
ment has touched even the soulless, sordid American Federa-
tion of Labor, and we find it giving really valuable aid, as
shown by the circulation of vast numbers of pamphlets re-
garding domestic methods of prophylaxis against tuberculosis,
and in various other ways.

At last physicians have ceased to fight their battles un-
aided by those for whom they fight ; and when w^e remember
that this combined campaign has only just begun, and con-
sider the results already achieved; armed with the weapons
of modern therapy and sanitation, we may confidently meet
whatever conflicts the future holds in store.

294 FIFTY-FIFTH ANNUAL SESSION

Sanitation is the last grand advance of scientific medicine
and the noblest expression of medical altruism. Observing
its marvelous development in the past, and its infiinite pos-
sibilities for the future, we realize how truly, says the world's
foremost physician : ''Could Hippocrates meet again a class
of students at some modern Cos and discuss the changes
which twenty-five centuries had wrought, he would dwell
upon this latter development of the science and of the art as
the crowning benefit which the profession has bestowed upon
the race, and he would repeat again those noble words which
have found in this triumph their practical realization: 'To
serve the art of medicine as it should be served, one must
love his fellow-man.' "

N. C. MEDICAL, SOCIETY. 295

THE IMPORTAi^^CE OF THE WORK OF THE GE:\' ■
ERAL PRACTITIONER.

BY DR. L. B. m'bRAYER, ASHETN'ILLE, N. C.

Is there any room left for the general practitioner ? One
would not thing so when he thinks of the many different spe-
cialties. There is the dermatologist, the anrist, rhinologist,
laryngologist, gynecologist, stomatologist, G. U. specialist,
proctologist, abdominal surgeon, naval surgeon, general sur-
geon, tuberculosis specialists, specialists on diseases of the
eye, ear, nose, throat and chest, obstetrician, podiatrist, path-
ologist, bacteriologist, neurologist, alienist, opthalmologist,
psj'chiatrist, chiropodist, habit cure specialist, osteopath, who
is now a legal practitioner in this State, etc., on do\vn.

Then what is left for the general practitioner ? Oh, yes !
you say, scarletina, diphtheria, etc. But that is claimed by
the pediatrist and said claim is disputed by the dermatologist
and the laryngologist. Well, you say, fevers affecting those
above the age of puberty, other than the eniptive fevers M^hich
belong to the dermatologist and child-bed fever, which is
properly assigned to the obstetrician. Until recently you
would have been correct, but of late our own Dr. Register has
found this to be the only field unoccupied by the specialist,
and he has coined a new specialty — that of fevers — and has
established an enviable reputation in that line, even writing
books on his new specialty. And from the great success he is
achieving I have no doubt many wall be induced to take up
this specialty.

Is the office of the general practitioner then nothing more
than the assorting room in a laundry, where the bundles are
brought in, assorted and labeled and passed up to the proper
department ? Or is the general practitioner nothing more
than a floor-walker in a large department store whose duty it
is to see that all inquirers arrive at the proper place ?

296 FIFTY-FIFTH AN2s"UAL SESSIONS'

Not so; the general practitioner must be as able to make a
diagnosis in appendicitis and other siu'gical diseases as the
surgeon, and must know as well when an operation is de-
manded. He must know the symptoms of ruptured tubal
pregnancy or carcinoma uteri as well as the gynecologist, and
if he does not operate himself he must know when an opera-
tion is necessary and must always be able to advise his patient
intelligently and truthfully when to have and when not to
have an operation. He must be able to make as early a diag-
nosis of tuberculosis as the tuberculosis specialist, and should
be fully as competent to treat it.

He should use the pathologist, bacteriologist, surgeon and
these other specialists to help him in making a diagnosis and
in helping Imn to treat his patients and not be used by them.

He should act as a safety valve to these specialists, or he
should stand in relation to them as does the rudder to the
ship.

]^ow 'tis very well known that all these specialists are more
or less feudists. The only sane man is the one who stands four
square to every wind that blows, who has no hobby, who
weighs everything properly and gives to everything its proper
weight, who is well balanced, who never chases a rainbow.
We all knov7 that in this world we most often find the things
we are looking for. You remember the story of the queen
who called two of her subjects and said to one. Go gather all
the flowers in my kingdom, and to the other she commanded,
Go gather all the thorns and thistles in my kingdom. T]ie
first returned and reported : May it please your majesty,
the task is too great; there is nothing in your kingdom but
flowers. The second likewise reported : The task is greater
than a million men could accomplish, for I find thorns and
thistles everywhere. You no doubt remember the story of a
rich woman that went the round of all the specialists. The
neurologist gave her electricity, hydro-therapy, etc. ; the tu-
berculosis specialist gave her the rest cure and serum-thei'apy ;
the surgeon did a nephropexy, and the gynecologist did a

N. C. MEDICAL SOCIETY. 297

cui'ettage, ventro-lixatioii and ovariotomy, aud so on, nntil
she had run the gamut, suffering many things at the hands of
the doctors, and like the man in the Bible her last state was
worse than her first; until finally she went to a general prac-
titioner and he gave her a dose of lig. Chlo. Mitis and cured
her.

As a matter of fact I attended a medical meeting on one
occasion and heard three men read papers, and each one of
them declared most positively that 33 1-3 - per cent of the
human race were suffering with the malady that he was rid-
ing as a hobby at that time, and required the special treat-
ment that he had been using ; in one case an operation, which
was plain to see the surgeon hoped would bear his name ; and
which I may remark in passing is hardly considered a legiti-
mate operation and is never done by some of the greatest
surgeons of to-day.

And so I say the general practitioner must act as a safety
valve. It seems necessary to the existence of these specialists
that they should ever and anon, under the inspiration of their
work, get on an extra heavy head of steam, and the general
practitioner acting as a safety valve will allow them to bl.^w
off and no harm come of it. Listen to these men, they are
usually well posted in their line ; learn of them ; but it is not
necessary for you to accept everything they say until you
have proven it true. Have the bacteriologist help you in mak-
ing your diagnosis, but if he fails to find the tubercle bacillus,
when you have many of the symptoms of tuberculosis, don't
wait on him but make your diagnosis and he will corroborate
you later. On the other hand, if he finds the klebs-loefler
bacillus in a healthy throat, it is not necessary or wise for you
to quarantine your patient.

If you call a surgeon in to see a patient with you and, after
failing to find anything else in his line, he finds an imaginary
appendicitis and describes with great eclat and holy horror
the terrible abyss over which your patient is hanging, when
you know she has never had appendicitis, have the manhood

298 FIFTY-FIFTH ANNUAL SESSION

to say so, and here's hoping you will have the confidence of
your patient so securely that she will never spend an unpleas-
ant moment on account of the consultant's enthusiasm over
his hobby. Just act as a safetj^ valve for him and no harm
will come to any one.

The greatest need of the medical profession at this time is
the ability to make an early diagnosis, and these specialists
are all dependent on the general practitioner to make this
diagnosis. Take, for example, perforation in typhoid: an
operation in the first few hours gives a good chance to save
life ; postponed twenty-four hours on account of the general
practitioner failing to make a diagnosis and the case is hope-
less. Perforative appendicitis is almost equally as fatal if
operation is postponed for a few hours ; the general prac-
titioner is responsible. Volvulus, intus-susception and ob-
struction of the bowels from other causes are only susceptible
of a cure if diagnosis is made inside of a few hours. The
general practitioner is the man who has the patient in charge.
Probably the greatest good the tuberculosis specialist has
done is in stressilig the great importance of an early diagnosis,
and necessarily his lamentation has been directed to the gen-
eral practitioner, because this responsibility — and a great re-
sponsibility it is — falls upon his shoulders.

Cancer can be cured if only an early diagnosis is made
and proper treatment is instituted ; and again the general
practitionei* is the man who is first consulted and in whose
hands the destiny of the patient lies.

In extra-uterine pregTiancy it's the general practitioner
who must of necessity be gjmecologist and obstetrician, who
must make the diagnosis while it is easy to save life.

In diphtheria the general practitioner can not always have
the bacteriologist at his command to confirm his diagnosis,
and if he has and waits to institute treatment until he gets a
report, the child may be beyond the jDOSsibility of recovery.

I could go on at length but it is useless ; you have the idea.

Does the general practitioner then measure up to his re-

X. C. MEDICAL SOCIETY. 299

quirements ? lu the main, yes. Is lie as capable of making
an early diagnosis in typhoid or appendicseal perforation as
the surgeon ? There is certainly no reason why he should
not be. Is he as cajDable of making a diagnosis of extra-
uterine pregTiancy as the obstetrician or gynecologist ? If
not, why not ?

Then it is apparent that the general practitioner must be
as well posted on the symptoms and treatment too, if you
please, of all diseases as the specialist is in his line. He may
not be able to properly conduct the treatment for all diseases,
but this is no reflection on_him. Do you know any one who
is? Isn't the field of surgery large enough for one man?
Isn't the eye, and especially if you couple with it the
ear, nose and throat, enough for one man ? Do you think
that every general practitioner should equip himself to cover
the field of all the different specialties? Certainly not; this
would be impossible if only the armamentarium were con-
sidered ; but unless he does equip himself mentally as well as
any and all the different specialists he does not measure up to
the requirements of his profession.

"All work and no play makes Jack a dull boy" is true to-
day, and is true as regards the medical profession. The
specialists have a way that amounts to a fad of taking a week
or two off once a year or once in two years and going to the
medical centers to watch the work of their confreres in their
line. The ablest men we have do this. It is nothing uncom-
mon to run across Ochsner or the Mayos in New York at-
tending the clinics of Gibney, Coley, Bull, Wycth and the
others. Likewise at the ]\Iayos' clinic Vou will meet men
from IvTew York, Philadelphia, Boston, Frisco, Fayetteville,
High Point, Asheville, Berlin and all points I^orth, South.
East and West.

The general practitioner wo*'ks longer hours, more days and
more nights than the specialist, and if anybody deserves a
vacation once in a while it is the general practitioner. You
owe it to yourself, you owe it to your patients, and your
patients owe it to you. So tear yourself away and visit your

300 FIFTY-FIFTH ABTNUAL SESSION

confreres in the medical centers in your own and other States,
and across the pond if you like. It will make you a better
doctor and therefore you will be worth more to your patients
and your community. Your patients will feel a pride in the
fact that their family physician has gone to the city to see if
there is anything new going on in medicine, and if perchance
you should feel that you are really worth more to your pa-
tents and should let it appear in the bills, there will usually
be no kick coming. Of course your patients will get sick in
your absence and will have to call another doctor, but what
difference does it make ? If you are worthy of them and they
are worthy of you they will return to you ; and if not, others
will come in their stead.

Again, if you make a diagnosis of tubal pregTiancy and
submit your patient to the gynecologist of your choice for
operation, go along, watch him operate, see if your diagnosis
is correct; or, if you have had the specialist in consultation,
see if he can square his diag-nosis with the facts. It will do
you good. You will be worth more in your professional life
for having done so. You know we don't study pathology in
the dissecting room or at the autopsy table any more ; but, as
John B. Deaver aptly puts it, in this day of advancement we
study living pathology.

May I ask again is there any room for the general prac-
titioner? Most emphatically yes. The general practitioner
is the basic work, the ground work of our profession. The
specialist may perchance rise to heights of fame that the gen-
eral practitioner may never see. He may become reno^vned
and hear the shouts of glad acclaim from the applauding
multitude that may never reach the ear of the general prac-
titioner, but to reach these heights, to gain this renown he
must use the general practitioner as a stepping-stone. And
when we shall all stand before the Great Physician, who will
reward with candor and judge wuth impartiality, methinks
I can hear the Judge say to the general practitioner, come up
higher, "for he that is least among you all, the same shall be
the greatest."

K. C. MEDICAL SOCIETY. 301

I can not close without saying a word in commendation of
the profession that composes the Medical Society of the State
of Xorth Carolina. Time Avas, within the memory of most
of us, when if an operation of any kind was needed the pa-
tient must needs journey to the city of Baltimore or Phila-
delphia or New York, but not so any more. In almost every
city in our grand old State we have well-equipped hospitals
at which any and all kinds of operations can be and are done
by our own native doctors, with equal ability and ofttimes
with better results than is obtained in the larger hospitals in
our larger cities. To-day the medical profession of our grand
Old Xorth State is wide awake and up and doing. A new
operation of great importance is done by some of our gTeat
men in some of our great hospitals to-day; you need not be
surprised if it is done in ISTorth Carolina by a iS'orth Caro-
lina surgeon to-morrow.

A new treatment for tuberculosis is promulgated from the
continent by cable, possibly to the Neiv York World. Our
learned specialists in Greensboro and Asheville will be using
it next week. The investigation of pellagra, a preliminary
report of which is presented under my section by Drs. Wood,
Lavinder, McCampbell and others, is worthy a place beside
the work done in the Carnegie Institute for Original Research
in Xew York, and will have a valuable place in the medical
literature for all time.

Only last year, when our State School Book Commission
was preparing to adopt books for our public schools for a
period of five years, a request was made that the company
furnishing the books on physiology and hygiene be required
to have a chapter on tuberculosis and its prophylaxis. The
request was gi'anted, the chapter was submitted to the Secre-
tary of our State Board of Health and other leaders in the
profession in this State for their approval, and is now being
studied in every public school in our grand old State, and to
my personal knowledge this chapter is attracting attention
in manv States.

302 riFTY-riFTH annual session

And may I be pardoned if I say that this Society has had
much to do with bringing about this spirit of progressive
medicine throughout the length and breadth of our beloved
State. All honor to the men of our profession who have
helped to bring about this happy state of affairs. Some of
them have gone to their final reward ; all honor to their mem-
ory and peace to their ashes. And let those of us who are here
realize the great responsibility resting upon us and march
forward shoulder to shoulder, hand in hand, conquering and
to conquer.

N. C. MEDICAL SOCIETY. 303

PELLAGEA— ETIOLOGY A^T) PATHOLOGY.

BY C. H. LAVINDER, M.D.,

United States Public Health and Marine Hospital Service, Wilmington, N. C.

In appearing before you to read a jDaper on the etiology
and pathology of so ancient a subject as pellagra with notli-
ing whatever to offer that is new, I feel that some explana-
tion is necessary.

It is true that pellagra is an old subject, and it is equally
true that the literature of the subject is extensive, the list of
titles in the Index Catalogue of the Surgeon's General Li-
brary covering some eight or nine pages ; but for all of this I
venture to say that to most American physicians pellagra is
little more than a name. And why should it be otherwise ?
Until lately it was a disease which did not concern us except in
an academic way. More or less recently, however, a disease,
which is possibly true pellagra, has appeared in the Southern
United States and the question may possibly soon become a
very practical and important one, at least for the Southern
physician, if indeed it has not already done so. In addition
to this most of the literature on pellagra is not readily avail-
able to many physicians.

To those who arranged the program of this meeting such
considerations have seemed sufficient for the insertion of one
or more papers on pellagra, and I think their wisdom will be
approved. For if w^e are to have pellagra among us it be-
hooves us all at once to learn something of a disease which
since early in the eighteenth century has been, and still is,
a veritable plague to some parts of the Old World.

ETIOLOGY.

In discussing the etiology of any disease whose cause is not
definitely known one must expect to meet many and varied
theories, and pellagra is no exception. Procopiu,^ in his mono-
graph, lists no less than twenty-one theories of its causation,
many of which possess, it is true, only historic value.

304: FIPTY-FIFTH ANNUAL SESSION

The disease we call pellagra was first described by Casal, a
Spanish physician of Oviedo, in 1735. He had observed it
among the Spanish peasantry, and finding nothing in the
literature to aid him, called it mal de la rosa, or the rose
disease (from its characteristic erythema). He regarded it
as a kind of leprosy.

Following Casal, during the next few years, a good deal of
Spanish literature appeared, and the disease was described
under a variety of names.

In Italy pellagra was first noted in 1771. The disease
rapidly spread and a large Italian literature followed, and
again the disease was described under a number of different
names. By 1784 the disease had become of such importance
that, under royal authority, a hospital was founded for a
study of its nature, and the elder Strambio, whose name is
associated so prominently with pellagra, was placed in charge.

The views regarding the nature of the disease were various.
Some called it a kind of leprosy, others syphilis, scurvy, ma-
laria, etc.

About 1810 Giambatista Marzari published a notable and
remarkable paper on the subject, putting forward the view
that pellagra was due to the consumption of Indian corn.
His explanation of the relation between corn and pellagra
does not seem to have been very clear, but his paper marked
a new era in the study of the disease.

Following this paper, for the next few years, students of
pellagra seem to have been divided into two great schools —
the so-called maize and anti-maize schools, or those favoring
the theory that maize caused pellagra and those who opposed
this view.

In 1844, before the Congress of Milan, Ballardini, an
ardent advocate of the maize school, presented another note-
worthy paper on the subject, extending and developing the
maize theory by creating his so-called "verdet" theory. This
theory was that maize is pernicious only when, under the in-
fluence of a parasitic growth, it has undergone certain altera-

jS". c. medical society. 305

tions. He bad observed on maize a fungus, sporisorium
maidis, and from its resemblance to copper acetate (vert-de-
gris) witb its green color, be called it *'verdet."

Tbe "verdet'' tbeory found many supporters, and among
tbe most ardent of tbem Lombroso, wbo later developed tbe
tbeory very mucb.

In France pellagTa was first observed in 1812 by Hameau
(senior), a pbysician of Teste de Bucb (wbence tbe Frencb
name for tbe disease, maladle de la Teste). !Mucb Erencb
literature followed, and finally, in 1845, Tbeopbile Eoussel
wrote bis interesting work on pellagra, following tbis later
witb otber important publications. In tbese works be defi-
nitely establisbed tbe identity of mal de la rosa witb pellagra
and sustained witb great talent tbe ''verdet" tbeory. His
works remain classics.

In France as in Italy tbe maize and anti-maize scbools
waged incessant war over tbeir rival claims.

Tbere is mucb valuable German literature, altbougb tbe
disease does not occur in Germany.

From Roumania, wbere pellagra is endemic, bave come
also many valuable contributions.

Laying aside many tbeories of only bistoric value, one
migbt mention as of interest tbe view tbat pellagra is a va-
riety of leprosy. Tbis view will not bear scrutiny, but if
one sbould observe a case of pellagra witb a well-developed
erytbema, sucb as bas been seen in Wilmington, tbe error
could at least be regarded witb sympatby. Pellagra bas also
been considered a manifestation of otber diseases, as malaria,
sypbilis, scurvy, and even tubercle ; these ideas, likewise, will
not bear close examination, and some of tbem at least bave
arisen from tbe fact tbat otber diseases, like malaria, are
often associated witb pellagra.

Tben tbere is tbe view, still beld by some of tbe French
school, that pellagra is not a definite morbid entity, but only
a svmptom-complex found in cachexias of diverse origin, and

306 FIFTY-FIFTH ANNUAL SESSION

that pellagrous erythema is only a common, solar erythema
occurring in individuals predisposed by bad general physical
condition (Cecconi)." This view is held by most authorities
to be erroneous and to be explained by the fact that such ob-
servers have confounded true pellagra with a certain symptom-
complex, analogous to true pellagra, which may sometimes
arise in cachectic persons. Such cases are said, however, to
differ from true pellagra, and the differentiation is also said
to be easily made by an experienced observer. For the want
of a better term such cases are called pseudo-pellagra or false
pellagra, that is to say, not pellagra at all. This distinction
is very forcefully made by students of the disease, but to
many the distinction does not always seem so clear. Mis-
taking effect for cause, insanity has been given as a cause.
Alcoholism and poor food with bad hygienic surroundings
have also been urged as etiological factors, but when one con-
siders that these factors are ubiquitous, whereas pellagra is
geographically limited to a rather small area, they can at
least be regarded with much doubt.

By reason of the seasonal periodicity of pellagra the sun
and heat have been advanced as causes, but the same objec-
tions may be urged against them. Exclusive vegetable diet,
the use of various cereals and other foods have also been given
as causes.

Quite naturally, also, the disease has been regarded by
some as an infectious disease. Several workers claim to have
isolated micro-organisms from the blood and organs of pella-
grins, but so far none of these observations have been con-
firmed, and all rest under much doubt. It is of course pos-
sible that the disease may prove of an infectious nature, but
there are good reasons against such a view; for if pellagra be
due to eating altered maize (as seems most probable) then
the high temperature to which maize is submitted in its prepa-
ration as food would seem to render it sterile.

This brings us to a brief consideration of the maize theory.
This theory, first put forward by Marzari, later developed
and extended by Ballardini, has found perhaps its most ar-

N. C. MEDICAL SOCIETY. 307

dent supporter in Lombroso, and is the theory which in one
form is now accepted by the great majority of students of the
disease.

Marzari, while he seemed certain of the causal relation ex-
istent between maize and pellagra, did not have apparently
very clear perceptions as to this relation. His idea seems to
have been a sort of metabolic (if you will allow this forced
sense of the word) one, that it is to say, he seems to have
thought maize lacking in certain essential food qualities, and
when used as food, extensively or exclusively, it produced dis-
ease by reason of lacking these qualities.

Ballardini, in his "verdet theory," believed that, due to a
certain parasitic growth (sporisorium inaidis) on maize, there
Avas developed a toxic substance in the grain which, on being
used as food, caused the intoxication, pellagra.

Lombroso, however, found many fungi on maize, aspergilius
glaucus, penicilium glaucum, and others, and affirmed that
sporisorium maidis is rare. No species seems to be constant
enough to be rated as the only cause.

The exact relation between pellagra and altered or spoiled
maize seems to have furnished a variety of opinions. Marzari,
as was stated, had a sort of metabolic view. Others, with a
little difference, adopted this view, affirming that the change
produced in the maize by parasites does not necessarily create
a toxic substance, but simply alters the food value of the
maize. To all of these so-called metabolic theories it would
seem that a full and convincing reply can be found in the
elaborate chemical analysis and biologic experiments to which
maize has been submitted to determine its food value. With-
out quoting the data, it seems to have been clearly shown that
maize is a good and easily assimilable food ; and further, that
while it may lose something by alteration under the influence
of fungous growths, such loss is insufficient to account for
pellagra.

There are others who have viewed pellagra as an auto-
intoxication, explaining that a constant or exclusive maize
diet makes certain changes in the vegetating properties of the

308 PIFTY-FIFTH ANNUAL SESSION

intestinal flora, whereby a toxic substance is produced in the
intestinal tract and absorbed therefrom. Di Donna has
stated that the colon bacillus, under such conditions, will take
on an increased and specific virulence. There are still other;
who regard the disease as an intestinal mycosis, the oflending
organisms being eaten with the maize, localizing in the intes-
tinal tract and producing an intoxication. All of these views
lack confirmation and have much against their acceptance.

The view which has found almost general acceptance among
students of the disease is that by reason of certain changes
wrought in maize by the growth thereon of certain undetei-
mined parasites (fungi), a poisonous substance (or sub-
stances) of a, chemical nature is produced, and that this sub-
stance (or substances) causes in persons who use such maize
as food an intoxication disease, pellagra.

Procopiu^ says : ''Maize altered by certain fungi, employed
as food, iicts by one or more poisons (probably ptomaines),
produced by these parasites, in causing pellagra."

Tuczek* says: ''Pellagra is an intoxication disease. This
teaching * * * can not be seriously questioned."

Babes and Sion^ say : "All authors, who have of late years
taken an especial interest in pellagra, excepting where pella-
gra is confounded with pseudo-pellagra, always confirm anew
the dependence of pellagra on the use of spoiled maize as
food."

As to the nature of this change in maize and of the toxic
substances formed, not a great deal is definitely known. By
some the poisonous substance or substances are regarded fis
ptomaines. Lombroso, working with the chemist, Erba, iso-
lated from spoiled maize certain toxic substances, a watery
extract, an alcoholic extract (which he called pellagrozein)
and an oil, also in very small quantity an alkaloidal substance,
which produced spastic conditions.

He thought that in altered maize there might be two dif-
ferent poisonous properties which, in their combined action,
could produce the symptom-complex of pellagra — one con-
tained in the alcoholic extract and the oil, having an action

X. C. MEDICAL SOCIETY. 309

something like the alkaloid strychnine ; and the other in the
watery extract, a narcotic substance like that found in hern-
lock, and in its action allied to nicotine. The exact chemical
nature of these substances remains undetermined.

Some other workers report a tetanizing alkaloid in altered
maize.

The last word has apparently not yet been spoken by the
chemists.

Exjoerimentally Lombroso fed hnman beings and several
varieties of animals on the poisonous substances he had iso-
lated, and caused a disease picture wdiich in some respects
was analogous to pellagra,

Procopiu^ also has given tinctures of spoiled maize to
human beings with similar results. Babes likewise has made
similar experiments with similar results.

Besides this Babes, with others, has made investigations
with regard to an antitoxin in the blood of pellagrins.
"Working with Mile. Manicatide, he has injected subcuta-
neously aqueous and alcoholic extracts of altered maize in
dogs and mice with resulting death after presenting symp-
toms in some respects analogous to pellagra. Also he has in-
jected such extracts and simultaneously blood serum ob-
tained from cured pellagrins, with the result that the animals
survived much longer. With regard to this antitoxine Babes
and Sion^ say : "It can not so far be impugned that in the
blood of a pellagrin there exists a substance which possesses
the property of antagonizing the toxic action of extracts made
from altered maize." Triller,® Gosio'^ and others have ex-
pressed similar views.

In support of the relation between maize and pellagra
many other important facts have been noted.

Pellagra appeared in the Old World only after the intro-
duction of maize culture from America, and no mention of
such a disease is said to be found in the older authors.

Where pellagra occurs it is always worse among the rural
population, and it is the rural population which subsist largely
on maize, and most often altered maize. They prepare it in

310 FIFTY-FIFTH ANNUAL SESSION

many ways, but most often in the form of a paste or hasty
pudding made by boiling corn meal in salt water — called in
France gaude, in Italy polenta, in Roumania mamaliga.

In countries where maize is grown and pellagra is not seen
or is rare, maize is not used so extensively or exclusively as
food (Austria, Greece, Asia Minor, Egypt, etc.) ; or else the
hygienic conditions are better and the climate is far more
adapted to raising a good quality of maize, maturing and
properly storing it (United States). It seems to be admitted
by all that improperly matured and stored maize is most
likely to undergo alteration.

Antonin^ observed in Galicia (a province of Austria) pel-
lagrins among robust males, but never among women and
children. Maize is unknown in this province. Upon inves-
tigation he learned that the men passed some months of the
year in Roumania and as laborers were compelled to feed on
gaude.

]\Iany observers report pellagrins cured, or their condition
ameliorated, by withdrawing maize and substituting good
food, especialy if done more or less early in the disease.

Zantedeschi^ reported to Ballardini that pellagra disap-
peared from Borejno in 1816-17, when, by reason of high
price of maize, the poor had to subsist on potatoes and other
vegetables.

Zambelli^ states that young pellagrins who become soldiers
soon become sound and healthy.

These and similar facts speak eloquently of some casual
relation between maize and pellagra, but the definite relation
existing still remains in some doubt.

It is worthy of mention that Procopiu^ and others believe
that alcohol (whiskey) distilled from spoiled maize may con-
tain the pellagrogenous poison.

Among the causes which may be classed as predisposing
may be mentioned the following:

Individual Predisposition. — Is often evident, as one would
naturally expect. Boudin,^ in 140 cases, gives one case onl,>
in a family, 67 per cent, more than one, 33 per cent.

y. C. MEDICAL SOCIETY. 311

Heredity. — The disease does not seem to be hereditary, but
it is stated that the children of generations of pellagi-ins are
of feeble resistance and lowered physical vitality.

Sex. — There seems to be but little difference.

Age. — The statements are discordant on this point. Proc>
piu^ says the disease is more frequent from early age up to
20 years. Triller® quotes Potarca as saying that the disease
is two or three times more frequent between 20 and 40
years. The disease does not seem to occur among infants
unless they are fed on maize.

Seasons, Heat and Sun. — These factors seem to have only
an indirect effect. It seems to be generally admitted that the
chemical rays of the sun may act as an exciting cause for the
erythema in those who already have the disease. Further,
heat and the seasons have a decided indirect effect in the de-
velopment of fungi on the maize.

Other Diseases. — Act only by lowering resistance. Preg-
nancy and lactation are stated to predispose.

Alcoholism. — Said to act only by lowering resistance unless
made of alcohol distilled from altered maize.

Contagion. — The disease does not seem to be contagious in
any way. Pellagrins may associate intimately with the well
and there is no effect unless altered maize is used as food.
Procopiu^ states that Boniva attempted to inoculate the dis-
ease with blood and saliva, but obtained no result.

PATHOEOGIC A:N^AT0MY.

The morbid anatomy of the disease is to some extent in-
constant, and can hardly be considered characteristic.
Tuczek* points out the fact that from the variety of the dis-
ease picture one could hardly expect to find a single, -definite
condition, and further, that in many reports there are in-
cluded heterogeneous and manifold accidental lesions which
would naturally occur in a very chronic disease where the
lesions of senile involution and of intercurrent maladies may
also be looked for.

As part appearances of cachexia he includes atrophy of the

312 FIFTY-FIFTH ANKUAL SESSION

subcutaneous fat and musculature, brittleness of the bones,
atrophy and tendency to fatty degeneration of the internal
organs, especially those innervated by the vagus : kidneys,
spleen, liver, intestines and lungs.

He further notes three groups of morbid changes :

(1) Of the intestinal tract. Thinning of the walls in con-
sequence of atrophy of the muscularis, not seldom hyperajmia
and ulcer formation in the lower part of the intestine.

(2) Abnormal pigmentation, especially of the ganglion
cells, heart musculature (brown atrophy) liver cells and
spleen.

(3) Alterations in the nervous system, which are very im-
portant. He states that the variously described conditions
of hyperemia, ana?inia and oedema, as well as some inflamma-
tory conditions of the central nervous system and its cover-
ings, can not be attributed to pellagra. The same conditions
occur in many other morbid conditions. He further states
that the findings in the brain are practically negative.

In the spinal cord he has described various degenerative
lesions, most often and most extensive in the posterior col-
umns, and in the lateral columns, also occasionally in otlier
locations.

He further states that typhoid pellagra has no special
pathology.

Lombroso summed up the morbid findings in pellagra as
follows : atrophy, fatty degeneration, hyperasmia, pigmenta-
tion.

Marinesco described degenerative and pigmentary changes
in cerebral cells, as well as in pyramidal neuroglia cells.
Babes and Sion have described similar lesions.

Babes and Sion have also noted the resemblance between
the morbid lesions of pellagra and those of tabes dorsalis,
but this resemblance is said only to begin when the process
is much advanced.

Proliferation and obliteration of the central canal of the
cord has been noted by several observers.

X. C. MEDICAL SOCIETY. 313

Tuczek thinks deg'enerative changes in the peripheral nerves
should be viewed with caution when one considers the great
frequency of such conditions in chronic illness.

Babes regards the skin lesions of tropho-neurotic origin.

PATHOGENESIS.

In the pathogenesis Procopiu gives some very suggestive
ideas. He points out that pellagra is an intoxication disease
of great chronicity; that the greatest force of the poison is
expended on the nervous system ; that our lack of knowledge
as to the chemical nature of the poison or poisons leaves us
in gTeat doubt as to the mode of action, leng-th of stay in the
body and method of elimination.

He suggests that perhaps elimination takes place from skin
and mucous membranes, giving rise to the exanthem (erythe-
ma), and the enanthem (stomatitis and intestinal hypene-
mia), though it is not to be forgotten that these symptoms
may depend on changes in the nervous system (trophic).
He also suggests that the great chronicity of the disease and
the slow progress to recovery, when this takes place, gives rise
to the thought that the poison or poisons may be very slowly
absorbed and equally as slowly eliminated.

It is worth noting, too, that Triller devotes a short chapter
to the chronic and recurrent ^ature of the malady, discussing
the question as to whether we must regard the disease as a
chronic disease with periodical recurrent manifestations
(exacerbations), regardless of a continuously acting cause, or
whether it is simply a question of recurrent repoisoning.
The nature of the disease and the weight of authority seem,
however, to be on the side of the view that it is a very chronic
disease with recurrent manifestations.

CONCLUSION.

Finally, to refer briefly to the cases we have seen in and
around Wilmington, we have, so far as conditions would per-
mit, studied the few cases coming under our observation both
clinically and pathologically. Our material for such study
has not been very abundant, however.

314 FIFTY-FIFTH ANNUAL SESSION

Working with Dr. E. J. Wood, of Wilmington, I have
made blood cultures from 'three cases, and from one of these
on two occasions. From two of the cultures I have isolated
a bacillus, which from tinctorial reactions and morphological
appearances seem identical, but they differ somewhat in cul-
tural peculiarities. It is possibly a contamination, but will
require further investigation. In one necropsy we have also
made cultures from liver, spleen, kidney and spinal fluid, but
with no definite results as yet. We also have under investi-
gation some pathologic material, but at present our work is
too incomplete for a report. I may add that in making cul-
tures our hope was not so much to find a causal organism,
but simply to make as complete a study as possible in order
to prove or disprove whether the disease we have encountered
is, as most of us believe, true pellagra, and not one of the
conditions described as pseudo-pellagra.

In conclusion, I acknowledge my indebtedness, already
very evident, to the general literature of pellagTa. As I
stated, I have nothing new to offer, and my paper is but
little more than a resume of such literature as I have had the
time to consult.

I also wish to express my indebtedness to certain local prac-
titioners of Wilmington ; to Dr. T. M. Green for the privilege
of seeing a case ; to Dr. R. H. Bellamy, to whom belongs the
credit for having first suggested the nature of the disease in
Wilmington, for several favors ; and especially to Dr. E= J.
Wood, with whom I have had the privilege of doing a good
deal of work.

BIBLIOGRAPHY.

1. Procopiu, G. La Pellagre, Paris, 1903.

2. Cecconi, Erythemes pellagreux et E. pellagroides, Paris Theses, 1903.

3. Procopiu, loc. cit.

4. Tuckez, F. Klinische und Anat. Studien ii. die Pel., Berlin, 1893.

5. Babes und Sion. Spec. Path. ii. Therap., Nothnagel, Band XXIV, Hft.

II, Abth. II, III.
0. Triller, B., La Pellagre, Paris Theses, 190G.
7. Att. degli Cong. pel. ital., 1902- — art. "II Progresso degli studi

suH'etiologia della Pellagra.

N. C. MEDICAL SOCIETY.

315

THE PEOBLE^I OF THE GEXERAL PRACTI-
TIONER TO GYis^ECOLOGY.

BY J. ERNEST STOKES, M.D., SALISBURY, N. C.

The General Practitioner amid the affairs of mankind
stands out unique. As the years glide by and the centuries
come and go, all do^^Ti the history of the human race, we find
none whose deeds of love and acts of courage are greater than
those of this silent man — whom we call the General Practi-
tioner. With no orator or poet to sound forth his praises;
with no historian to record his efforts ; often sorely tried and
misjudged ; often weary and worn in heart as well as in body ;
with weapons inadequate for the struggle, only upheld by his
sense of duty and loyalty, he fights on, day after day and
night after night, silently but earnestly, his grim battles with
disease and death. Sooner or later, he, too, falls in the fight
— to the Avorld a life that is to be replaced by another ; but to
the Judge of all, a life that by its toil and devotion has added
something of brightness, or perhaps even something of glory
to the dark history of the human race.

In regard to all matters that pertain to property, posses-
sions, and money, men study and familiarize themselves there-
with, but as to the question of health and disease — although
involving life and death — men give but little study, leaving
these matters to the family physician, the General Practi-
tioner. And what a gigantic task it is that thus falls upon
this man whom we call the General Practitioner !

The human organism is the most wondrous structure on
earth. A living combination of things that would seem im-
possible of combination. Component parts that are essenti-
ally contradictory, the physical and the psychical, the mate-
rial and the immaterial, the mortal and the immortal, each
in itself as marvelous as the other ! The physical so intri-
cate, so complex, so manifold, as to have baffled human study

316 FIFTY-FIFTH AjSTXUAL SESSION

for over six thousand years. The jDsychical so mysterious
tliat only the voice of Faith can tell us whence it cometli or
whither it goeth ! And yet they are so united, and, as it
were, so interwoven that whatever affects the one necessarily
affects the other. To keep in tune and to restore, when lost,
the harmonious workings of this wondrous instrument is the
great task that falls upon the General Practitioner.

In deed too much credit can not be given, nor too much
praise spoken of the General Practitioner — the fondly trusted
family doctor, the private in our great army. "With him,
humanly speaking, are the issues of life and death, since upon
him falls the grievous responsibility in those terrible emer-
gencies, which bring darkness and despair to so many house-
holds."

Gynecology on the other hand is so closely allied to those
conditions associated with the very beginning of life, with
all its hopes, joys and happiness, that the General Practi-
tioner's relation to this specialty is one of more than passing
interest.

Gynecologic lesions are, generally speaking, assigned to
one of two groups, Major and Minor. To the first group be-
long those cases of gravity, which not only involve the health,
but may imperil the life of the patient. Conditions which
demand active and prompt treatment, and now in this period
of science and progress of medicine, it is not to be questioned,
surgical treatment in the hands of those specially prepared
by experience and training; while thoroughly equipped in
surroundings and appointments with every detail. It is the
second group however — the Minor Gynecologic diseases witli
which the General Practitioner is most closely associated, and
should be most deeply interested in. In this group, though
the life of the patient is not in danger, nor the health of the
patient even directly impaired, the restoration to health often
depends solely on the judicious action of the General Practi-
tioner.

N. C. MEDICAL SOCIETY. 317

The relationship of the General Practitioner to Gynecology
may be well likened to the connection between the Science
and the Art of medicine. \Yhere Science indicates the recog-
nition and study of the abnormal condition existing; while
the xVrt aims to remove the abnormal condition and to restore
and to maintain the normal state of health.

How far the General Practitioner shall enter the active
field of operative gynecology, or assume the responsibilities
of pelvic surgery with its unforseen intricacies and possible
exigencies, the writer makes no endeavor to decide. It is a
decision which each man is to make for himself, with a con-
science for a guide and God as his Judge. In view, however,
of the large and broad general medical information, with its
extensive scientific issues, which are incumbent upon the
General Practitioner to acquire for general practice, it would
be well, before entering the operative field, to remember one
of those ancient aphorisms, which is said to be still the most
certain and uncontrolled of any science has produced, and
which portrays a perfect understanding of both nature and
art — namely, "Art is long, life is short, experience deceptive,
opportunity sudden, decision difiicult."

The question then here arises how much gynecology should
the General Practitioner know ? As much as possible natu-
rally ; but certainly he should realize the great importance of
separating the real minor gynecologic lesions from the sup-
posed or imaginary ills and ailments referred too often to the
generative tract, and which so deeply affect certainly the
mind of the patient, even when not the body. For it is in
just this condition, that the General Practitioner can be more
potent than the specialist, as he knows more about the patient,
sees her earlier and more often. Yet it is just here that the
greatest errors of judgment may be made.

For the most part the General Practitioner makes a cor-
rect diagnosis of the presence of an existing lesion, but a
great error, far-reaching in effect, may be made by actually

318 FIFTY-FIFTH A^^^NUAL SESSION

connecting the array of general complaints of the jDatient to
that lesion. The patient is so advised of the lesion, and by
willing consent only too often local treatment is instituted.
Though this treatment may be successful and the local lesion
removed, the general symptoms and failing health neverthe-
less go on. So that the General Practitioner by injudi-
ciously associating a lesion, purely local in its effect, with the
patient's general remote symptoms may doom her to disap-
pointment. She at once begins to magnify trifles, and erro-
neous theories become fixed in her mind. The way is laid
for more extensive, almost interminable local treatments, and
the initial step taken for the final psycho-neurotic trend, with
the genito-urinary tract for a basis. On the other hand, the
family doctor can remove simply through sound judicious
advice many of the distressing discomforts of a supposed
minor gynecologic ailment; or by changing an unhealthy,
mode of living, on the part of his patient, relieve her of some
of the actually real ones. The patient will thus be spared
unnecessary meddling on the part of the General Practitioner,
and in many instances be kept away from the officious manipu-
lations of a specialist. For not infrequently, patients with very
unimportant minor ailments, some real, and others even sup-
posed, unnecessarily seek out the aid of a specialist, because
the General Practitioner has unfortunately associated in their
mind, a relationship of cause to effect, between the local and
general conditions. Yet he has failed to bring about the
tried-for relief. ISTaturally these patients becoming uneasy
and unsettled in mind, as well as in body, seek the aid of
specialist after specialist, expecting relief, and profoundly
impressed by the probable gravity of the ailment, when he,
too, fails. This is not without its significance, for in many
instances the specialist does fail in satisfactorily disassoci-
ating in the mind of the patient the local condition from the
general ill health. This difficulty is especially noticeable in
those cases of a local minor disturbance, accompanied by an

K. C. MEDICAL SOCIETY. 319

array of such symptoms as persistent headache ; backache
and spineache ; as well as in the intractable, aggravated forms
of dysmenorrhoea and leiichorrhcea, associated with hebi-
tude and obstinate constipation, loss of flesh and general
mental depression with nervousness and wakefulness. In
fact the ''minor diseases of women are usually associated
with many symptoms which in no way depend upon the local
disease, their relation being only that of dependence upon
a common cause." These patients are very much more in
need of the aid of the General Practitioner, as adviser and
friend, counselor, and companion, toward removing or
warding off some ulterior cause for the condition, than local
treatment or the services of a specialist.

In properly selected cases, the General Practitioner
should certanly give local treatments, correct displaced
wombs, and treat certain acute inflammatory conditions.
He should be ready and prepared to do such minor oi^era-
tions as dilatations, curettage, or repair a freshly ruptured
perineum; but in his relation to Gynecology the General
Practitioner's sphere of greatest activity and usefulness,
unquestionably, should be along hygienic and prophylactic
lines. This is a "field preeminently his." This is pre-
cisely along the line of progress in modern medicine.
Prophylaxis, for the elimination of diseases, is now de-
manded and enforced by civic authority, while the theories
and laws for an healthy mode of living are being more and
more disseminated by scientific lectures and popular ad-
dresses, in order to prolong life, do away with the ravages
of disease and make stronger the race of man. And yet
what greater blessing could befall the human race than the
rearing of perfectly developed young women freed from the
steadily increasing tendency to functional neuroses.

The natural life of woman may be divided into three
phases. First, from birth to puberty ; second, the period of
menstruation and possible child-bearing; third, the meno-
pause.

320 FIFTY-FIFTH ANNUAL SESSION

The first period does not come immediately iu line with
this paper. However, the projDer care, and actual handling
of the young growing girl, as she approaches puberty, have
so direct a bearing and intrinsic effect upon the second
period, that I quote without discussion — a pungent excerpt
from the "Psychology of Adolescence." "Rousseau would
leave the prepubescent years to nature, and to these primal
heredity impulsions and allow the fundamental traits of
savagery their fling until twelve. Biological Psycholog}'
finds many and cogent reasons to confirm this view if only
a proper environment could be provided." * * * "But
now another remove from nature seems to be made necessary
by the manifold knowledges and skills of our highly com-
l^lex civilization. We should transplant the human sapling,
I concede reluctantly, as early as eight, but not before, to
the school house with its imperfect lighting, ventilation,
temperature. We must shut out nature and open books.
The child must sit on unhygienic benches and work the tiny
muscles that wag the tong-ue and pen, and let all the others,
which constitute nearly half its weight, decay. Even if it
be prematurely, he must be subjected to special disciplines
and be apprenticed to the high qualities of adult-hood, for
he is not only a product of nature, but a candidate for high
developed humanity."

It is the second period, — the menstrual function and
child-bearing period — which offers a broad open field for
the General Practitioner. Properly cultivated, it is capa-
ble of yielding a rich harvest of the golden grain of strong,
robust girls, wives and mothers. This is the period of great
opportunity, of inestimable importance for medical gyne-
cology, and should hold the attention of the General Practi-
tioner. He should advise and instruct the young mother
regarding the hygiene and proper care of the girlhood of
the maturing daughter. The mother should know and fully
realize that the daughter's lack of physical development, back-

]Sr. C. MEDICAL SOCIETY. 321

ache, and irregularities of menstruation, as scanty, painful,
suppressed, with a host of other functional disorders, time
and again arise solely from a disregard of the fundamental
principles of hygiene; too close apj)lication to study and
from lack of sufficient physical culture and out-door exer-
cise. How often may one see a poorly developed nervous
girl, with all the irregularities of the menstrual function,
sitting hours and hours, day after day, preparing for her
musical recital; or striving for the highest honors at the ex-
pense of the development of her reproductive organs ! How
much better for civilization were these girls heiiiff so devel-
oped in body as to have the wholesome inclinations of woman-
hood and motherhood even though they be, as Portia describes
herself "an unlettered girl, unschooled, unpracticed."

Xathan Allen urged that while in men everything de-
pended upon bodily vigor, this was even more important for
girls, for in them we were educating the race. The best
balance for weak nerves or other organs was well developed
muscles, and in this at proper periods he saw the way of
safety for the well and for salvation for the sickly. Stated
and out of door and not excessive physical culture he thought
had formative influence upon the monthly function, and he,
too, held to periodic remission of work for mind, heart and
muscles.

The young girl should be taught by delicate, hygienic in-
struction, that the menstrual function is a sequence of de-
relopment and maturity, and not a "disagreeable function
nor a badge of inferiority." All her attempts at conceal-
ment by determined efforts to carry out her usual daily life,
or to meet her social obligations, irrespective of her condition
should be discouraged. Eather should she be taught the
dangerous ill effects of fatigue and excitement, and "the
need of rest, proper regimen and toilet."

As the General Practitioner should be adviser to mother
and daughter, so should he be counselor to husband and
21

322 FIFTY-FIFTH ANNUAL SESSION

wife. It is not difficult to understand the terrific burden
which falls upon the poorly developed girl on assuming the
duties of the strong mature wife. At first she meets her
marriage obligation, with all its attending consequences, to
later repel it ; wholly through the frailty of the generative
system. Finally, either from pure repulsion or actual fear
of maternity, the criminal abortion is accepted with all its
harrowing effects upon mind, body and morals. Here it is
that the General Practitioner can by positive and timely ad-
vice often ward off permanent invalidism or perhaps pre-
vent the necessity of finally seeking surgical intervention.
The constitution of woman at this period of her life has been
referred to by Oliver Wendell Holmes thus, "The American
female constitution which collapses just in the middle third
of life and comes out vulcanized India rubber, if it happens
to live through the period when health and strength are must
wanted."

The third period, or menopause, presents to the General
Practitioner a complex condition. In that the very symp-
toms the patient often notes, at this time, are referable to
other or more remote causes and are perfectly insignificant
as far as the change of life is concerned. She will again
ignore symptoms of the very greatest import, believing them
to be insignificant or a simple part of the on-coming cJiange.
In the first place it is the tendency of woman, after middle
life, to make the menopause a store room for many of her
ills and ailments, notwithstanding how far removed it may
actually be from being the cause. She is prone to considor
these minor ailments as indicative of the approaching change
of life several years ahead of its actual occurrence. So as
the months go by and the menopause does not become estalv
lished, the general array of symptoms increase in number
and severity and the patient passes into a condition very
aptly described in an extract taken from Dr. S. Weir Mitch-
ell's views. "ISTo one knows woman who does not know sick

N. C. MEDICAL SOCIETY. 323

woman." She takes to being a patient naturally and com-
fortably, although if long ill she warps morally. Her doctor
must often read the riot act to a mob of emotions; must
look beyond drugs, for she is prone to think three pills a day
easier than diet or regimen. He must listen and sympa-
thize with her ills and with the joy of convalescence in order
to be of real use to her. He must recogTiize how prone
nervous and feeble women are to crave pity and love power ;
how prone, like all who have not learned the great lesson of
bearing pain, they are to some narcotic habit. Out-of-door
life, the camp cure, sewing for its moral value, and all that
pertains to regimen and psychic influence must be at her
doctor's command." Undoubtedly there are many distress-
ing reflex symptoms directly referable to the approach of ttie
establishing of the menopause which call for and demand
appropriate treatment along hygienic and medicinal lines,
but it is those cases of increase and frequent menstruation,
occurring at this period of life which demand the greatest
caution and place the most grievous responsibility upon the
General Practitioner. The patient herself places little if
any significance as a rule to this change in the flow. The
General Practitioner, however, knowing that it is just at
this time that carcinoma is most frequent and uterine tu-
mors undergo changes in size and structure, should legard
this symptom with greatest apprehension.

Finally, regarding one of the most important points in
relation to the General Practioner to Gynecology — namely,
Diagnosis. In view of his broad domain, it is possible that
the General Practitioner may meet with any disease, whether
surgical, medical, or gynecological. This, indeed, would be
a terrific responsibility, necessitating a widespread knowl-
edge and diagnostic skill reaching over the whole field of
medicine, were it not for the specialist. One, who has de-
voted himself to one special line or sphere and who should
be better able, by special training and equipment, to tiandld

324 FIFTY-FIFTH ANNUAL SESSION

those cases belonging to his special line of work. Both the
General Practitioner and specialist work to one end — the
relief of the suffering, — so that their relations should be
one of cordial and harmonious cooperation. The General
Practitioner will meet a number of acutely grave conditions,
which though perhaps not demanding a positive diagnosis,
will call forth at least a prompt recognition of the serious
aspect, and the need for quick action. Such as in those cases
of internal hemorrhage and ruptured extra-uterine pregnan-
cies ; ovarian cyst with twisted pedicle and ruptured pus
tubes; appendicitis and peritonitis. There is no question
that the greatest good the General Practitioner can render
woman, and one of the greatest blessings he can offer man-
kind will be not only his own early recognition of carcinoma
of the uterus, but to so impress and ingraft upon the laity
the symptoms and the hopeless gravity when found late that
the laity will, too, appreciate the imperative necessity of an
early recognition of this disease.

In conclusion the relation of the General Practitioner to
Gynecology should be the application of his knowledge to
the narrow speciality, in such a way as to do the greatest
good to the greatest number. In order to accomplish this
both the General Practitioner and specialist should bear in
mind the following — "The knowledge, which a man can use
is the only real knowledge, the only knowledge which has
life and growth in it and converts itself into practical power.
The rest hangs like dust about the brain or dries like rain
drops off the stones."

^^^. C. MEDICAL SOCIETY. 325

THE MEDICAL Kv^FLUEISTCE OF THE Is^EGEO IK

CONI^ECTIOX \YITH A^^^MIA IK THE

WHITE RACE.

BY CH. WAEDELL STILES, PH. D.,

Chief of Division of Zoology, Hygienic Laboratory, U. S. Public Health and Marine-
Hospital Service.

Mr. President and Gentlemen: — In responding to your
kind invitation to return to Xorth Carolina 'and to address
jour meeting, I invite your attention to a certain phase of
the same subject upon which I spoke before you several years
ago. In my former address I discussed the general subject
of hook-worm disease. To-day I wish to speak on the 'negro
as a factor in the spread of this malady and his resulting in-
fluence upon the health of the white race. In bringing this
subject before you it is needless for me to state that I appeal
to no race prejudice, but that I simply bring forward certain
harsh, cold, scientific facts which must be faced, not only in
the interest of the white but in the interest of the negro as
well.

As many of you know. I have for some years past been es-
pecially interested in studying medico-zoological conditions in
the rural districts of the South, and this work has led me to
spend about a year living among the tenant whites. During
these studies I have made inquiries among all classes of people
regarding their ideas relative to the origin of the present im-
poverished financial and physical condition of the "crackers,"
"sand-hillers" and ''barrenites," and the information ob-
tained combined with my own investigations has led me to
a conception of these people which is not altogether in har-
mony with the general opinion entertained regarding them.
So far as I can analyze the subject these people are the joint
product of certain medical and industrial conditions as fol-
lows:

In ante-bellum davs, if a man 'was wealthy enou2:h to own

326 FIFTY-FIFTH ANNUAL SESSION

slaves he was wealthy enough to own good plantation land.
If not wealthy enough to owti slaves, it is not reasonable to
assume that he could buy the better class of farms. The lat-
ter people, therefore, would naturally be forced into the poorer
lands, if owners, or to serve as overseers, to become tenants;
and in general to compete with slave labor. Such seems to
me to be the most reasonable of the several explanations I
have heard regarding the origin of these people. In different
parts of the South they are known as "shad-bellies," poor
"Bukra," "poor whites," ^'crackers," "sand-hillers," "sand-
Billies," "barrenites," "poor Johns," etc.

The old-time negro had a great contempt for the white man
who could not own a slave, and this contempt culminated in
the expression "poor white trash." This same contempt is
reflected in the negro song, "I'd rather be a nigger than a
poor white man."

The expression "poor white trash" has become very well
known despite its offensive character, and unfortunately the
average more fortunate whites, both those who know these
people and those who have not seen them, have too commonly
allowed their judgment of these people to become somewhat
clouded by the judg-ment formed by, the old slaves. In fact,
very few persons have any sympathy for these people who
have been repeatedly referred to in my presence as "lazy,"
"shiftless," "good for nothing," "indolent," "untrustworthy,"
etc. One Southerner whom I recently met stated that he
had had twenty-five years experience with them and that he
considered "they were not worth trying to help" ; he was kind
enough to inform me that I was wasting my time in living
among them and studying their conditions. This reflects, in
an exaggerated form, the average opinion I have encountered
during my studies among these people, now carried on at va-
rious intervals for nearly six years, the total study amounting
to about one year's time.

Actual experience among them, for the purpose of scientific
study, and actual association with them, involving sleeping

N. C. MEDICAL SOCIETY. 327

in their homes, boarding with the '*dirt-eater" and '^sniiff-
dijjper," playing with their children, visiting their schools,
seeing them on farms, in mines, in mills, hospitals and or-
phanages have led me to a conception of them which is differ-
ent from those just mentioned, and I am forced to take radi-
cal issue with any person who looks upon them as "lazy,"
"indolent" or "good for nothing," and I can not refrain from
expressing surprise that any man should have twenty-five
years experience with them and use so little intelligence and
acumen as to come to the conclusion that they are "not worth
trying to help."

Since these people are j^eculiar to the South, in order to
understand them it is necessary to understand certain other
factors which are peculiar to this same region. There are
three factors in particular which come into consideration,
namely: (1) The area under discussion presents the most
intense negro population of any part of the country; (2)
this area also presents the area of most intense hook-worm
infection; and (3) the same area presents the most intense
malaria infection of any portion of the country. The ques-
tion now arises, In what relation do these four factors (the
tenant white people, the negroes, hook-worms and malaria)
stand to one another ?

I need not argue to you the fact that" both hook-worm dis-
ease and malaria are found both in the white and in the
negro, for this is well established. I may, however, invite
your especial attention to an important point, too often over-
looked, namely, that these two gi'eat ana?mia producing dis-
eases which are so severe on the white are relatively less severe
on the negro race. This fact, that the negro presents a rela-
tive immunity to the pJiysical effects of these two infections
which are so common to his race, is one of very gi*eat im-
portance for it points us to a conclusion from which there is
no escape, namely, that the negro race forms a great reservoir
for the supply of these infections.

Take malaria, for instance. It is a well-established fact

328 FIFTY-FIFTH ANNUAL SESSION

that the malaria parasite is exceedingly common in the blood
of negroes. It is a fact of common knowledge, which can be
easily verified by any doubting Thomas, that the negro does
not trouble himself very much to screen against mosquitoes.
What is the result ? Since the negro does not suffer from the
effects of this infection so severely as does the white, the
negro is not so likely as the white to come under medical
treatment, accordingly he is more likely to form a source of
infection to the mosquito; add to this the fact that he does
not screen against mosquitoes so much as does the white, it is
clear that relatively he forms a greater source of infection to
the mosquito than does the white. Now, let a white man take
what precautions he will against malaria in his family, the
mosquitoes in the negro's house on the back street still form
for this white man's family a source of danger over which he
has practically no control. The conclusion is evident. Theo-
retically and practically the negro race, living side by side
with the white race is, when viewed from the standpoint of
malaria, a great and serious reservoir of infection.

Take, next, hook-worm disease. A given infection with
this disease may put a white person in his grave or may make
him so sick that he remains at home and it is likely to bring
him under medical treatment. Thus, this infection is either
brought to an end or it is more or less confined to the immedi-
ate premises of this particular family.

That same infection will produce less serious physical re-
sults on the negro, who will, therefore, not be so likely to be
confined at home ; and he will not be so likely to come under
medical treatment. The conclusion naturally is that, rela-
tively, the negro is, and from theoretical conditions neces-
sarily must be, a greater spreader of hook-worm disease than
is the white man.

The immense importance of this latter fact can be seen
when we comjiare the white and the negro as a soil polluter.
In this connection I would state that I have collected statistics
for 366 farmhouses in ISTorth Carolina, South Carolina,

]Sr. C. MEDICAL SOCIETY. 329

Georgia and Alabama, and I find that of these 366 cases only
115 houses, or 31.4 per cent, were provided with privies of
any sort ; in other words, 251 of these houses, or 68.5 per
cent, had no privy, and on this account the soil pollution on
these premises reached a theoretical maximum. Of the 366
farmhouses in question, my records show that 73 were occu-
pied by whites and 83 by negroes, but I have no record of tlie
race of the occupants of the remaining 210 houses. Of the
73 houses occupied by whites, 56.1 per cent, or 41 houses, had
privies; and 43.8 per cent, or 32 houses, were without privies.
Of the 83 negro houses 20.4 per cent, or 17 houses, had priv-
ies; while 79.5 per cent, or 66 houses, had no privy. In
other words, the theoretical maximum of soil pollution was
reached in 43.8 per cent of the houses occupied by whites,
and in 79.5 per cent of the houses occupied by negroes. From
these statistics it would appear that the negro is nearly twice
the soil polluter that the white man is, and this conclusion is
in harmony with what we know of the generally poorer con-
dition of the negro privy when one is present, and also with
the complaints so often made regarding the pollution of alleys
in cities by the negro.

Comparing the white and the negro numerically as an in-
habitant, we find that in the States of Virginia, North Caro-
lina, South Carolina, Georgia, Florida, Alabama, Mississippi
and Louisiana the average ratio is 1,000 whites to 833 ne-
groes. The ratio in these States varies between 1,000 whites
to 494 negroes in ISTorth Carolina, and 1,000 whites to 1,415
negroes in Mississippi.

From the foregoing data it is seen that in the area under
discussion we have the following combination: (1) Two
races (whites and negroes) are living side by side; (2) as
inhabitants they bear the ratio of 1,000 whites to 833 negroes
( a proportion of negToes far in excess of what exists in other
States) ; (3) as soil polluters they bear the "i-atio of 438 (in
whites) to 795 (in negroes) ; (4) two diseases (hook-worm
disease spread by soil pollution, and malaria spread by mos-

330 FIFTY-FIFTH ANNUAL SESSION

qnitoes) are j^resent in high percentage; (5) these annemia-
producing diseases are especially severe on the white, but
relatively less severe on the negro.

To my mind the foregoing combination of facts leads in-
evitably to the conclnsion that the white race in the South
is living under a hygienic handicap, which is not paralleled
in any other part of the country, and were it not for the
greater intelligence and better financial condition of the
whites, whereby they are able to protect themselves more or
less against these diseases by sanitary measures, it would be
only a question of a few generations before this handicap
would exterminate the whites from those portions of the South
which are especially favorable to these infections.

These whites of higher education and in better financial
condition are able to protect themselves against this handi-
cap, the burden of which has therefore fallen more especially
upon that class (namely, the rural white tenant class) which
has been kept in financial impoverishment through gener-
ations of competition with negro labor, and the result is ex-
actly what theory demands it should be, namely, the present
impoverished physical condition of so many thousands of the
tenant wdiite people, especially those living in the sandy and
mountainous districts where the sanitary arrangements are so
inferior.

The physical condition of these people can be appreciated
only by persons who have been among them. Those of us
Avho have lived among them need not be surprised to find
their blood from 10 to 70 per cent below normal. IsTor need
we be surprised upon entering a poor farm hovel to foresee
death in many instances in 40 per cent of the children
(namely, two of the five or four of the ten children of the
family) before they reach twenty-one years of age. I visited
one farm on which I found father, mother, five children and
fifteen children's graves. I asked the physician what had
killed these fifteen children, and he replied : ''I do not know
what the disease is, but if vou can tell me what is killino; tltat

N. C. MEDICAL SOCIETY. 331

girl there joii will know what killed the other fifteen chil-
dren." ''That girl there" was a severe case of hook-worm dis-
ease in the dirt-eating stage. Think of it gentlemen! 75 per
cent of the rising generation of this family had already paid
the extreme penalty of soil pollution, and one further mem-
ber of the family already had one foot in the grave.

Gentlemen, let any one call me a theorist if he will, but in
all fairness to the tenant white class of the rural sand and
piney woods districts of the South, let him first see the sights
I have seen before he maizes fun of those 'people and before
he jokes about their sick and dying women and children. Be-
fore any man who claims to be humane considers these people
"lazy," "good for nothing" and "not worth trying to help,"
let him reflect upon the following statistics, based on about
10,000 examinations I have recently made among this class
of people :

1. At least 13 per cent (women over 20 years) to 18 per
cent (girls 16 to 20 years) of these women of maternity age
are suffering from the anaemia-producing hook-worm disease,
which prevents them from properly nourishing their babes.

2. Of the girls under 16 years at least IS. 7 per cent have
this same infection, which thus adds a serious strain upon
their bodies (in addition to the strain incident to their sex)
and Avhich tends to retard their physical development, so that
many of them reach maturity two to five years late, and even
after they have reached maturity this disease renders them
irregular in their menstrual functions.

3. Of the boys under 16 years at least 29.4 per cent have
this same infection, which inhibits both their physical and
their mental growth.

4. Of the boys 16 to 20 years 20.7 per cent, and of the
males over 20 years 5.8 per cent show these same symptoms
which decrease their labor capacity and their military effi-
ciency.

Xow, my friends, in all kindness, let me submit to you a
question for thoughtful consideration : Xearly a half-cen-

332 FIFTY-FIFTH ANNUAL SESSION

tury ago the country freed the slaves, but in these decades that
have elapsed since then what has our country done in order to
better the conditions of the tens of thousands of the rural
tenant whites who have been kept in financial poverty through
conipetitio7i with negro labor and in physical poverty through
the two great anaemia-producing diseases for which the negro
forms the great reservoir of infection^

All honor to the few noble men and women who by great
j)ersonal sacrifice are struggling to support efforts looking to
a betterment of their condition; all honor to the few physi-
cians who have let it be known that they will treat hook-worm
cases among these peojDle without professional fee; all honor
to the Southern cotton mill which is enabling thousands of
these people to earn an honest living, and thus to uplift them-
selves; but think a moment: In comparison ivith ivhat this
country is doing for the negro of the South, for the China-
man in Asia, and for other people of different races, what is
our country doing in order to elevate these tens of thousands
of people of our own race in our own country?

Does it tend to elevate them if we refer to them as "lazy"
and as "good for nothing?" Would it not help them more
if we could send to the chaingang people who indulge in that
kind of pseudo-wit ?

Gentlemen, there is a rational solution to the problem be-
fore us, and I submit to you for consideration a plan which I
maintain is well founded from a theoretical point of view and
feasible from a practical point of vieAV, It is the same plan
which I submitted a few days ago to the Alabama State Medi-
cal Association and which that Association has unanimously
endorsed. It is this :

Let us start out on the general principle that it is much
easier to teach children than adults. With this truth in mind,
I propose the introduction of a "Public Health Week" into
every schoolroom in the South. During this week let us uti-
lise the class in physiology in order to teach to the children
the three great and fundamental principles of public health
so important for the South. These principles are :

]Sr. C. MEDICAL SOCIETY. OOO

1. Do not spit on the floor, for this habit spreads tubercu-
losis aud diphtheria.

2. Do not pollute the soil, for this habit spreads typhoid
fever and ground itch, with its resulting hook-worm disease.

3. Protect against mosquitoes, for mosquitoes spread ma-
laria, yellow fever, dengaie and elephant foot.

Besides working through the schools, let us use every other
means by w^hich we can carry on a merciless campaign
against soil pollution. In the last analysis, soil pollution is
an evil in itself; it is in the nature of "malum in se" ; it is
an '"aggTavated offense against the public welfare; hence it
should be prohibited and made a crime, and any person guilty
of polluting a highway or back alley should be sent to the
chaingang.

Let us extend this campaign to the farms, especially, and
if possible persuade, but if necessary compel the farmer to
build a sanitary privy and to keep it clean.

Let us appeal to the clergy, to the lawyers, to the business
men, and especially to the school-teachers and the mothers, to
join in this campaign. If I can gain the mothers of the South
for this movement, and be given a chance to do so, I will agree
to practically eradicate hook-worm disease from the South
in one generation's time, and by this eradication I will agree
to elevate the condition of the rural tenant whites.

In conclusion, gentlemen, let me emphasize a very impor-
tant point in the plan I propose, namely, that it is absolutely
necessary to avoid any distinction between the whites and
the negroes in this campaign of sanitary education, for :

(a) The white man who fails to recognize the important ne-
cessity of improving the sanitary conditions under w^hich the
negro is living, fails to go to the root of the evil, and he uncon-
sciously invites disease and death, especially to the women and
children of his own race ; while

(b) The negro who fails to recognize the important neces-
sity of improving the sanitary conditions under which the ne-
gro is living, overlooks the fact that he is placing a very serious

334 FIFTY-FIFTH ANNUAL SESSION

handicap in the way of a higher mental development of his
race ; for the point must not be forgotten that hook-worm dis-
ease, in addition to its physical effects, to which the negro is
relatively immune, has also a serious effect upon the mental-
ity, and it has not been shown that the negro is immune to
this latter effect.

]S'. C. MEDICAL SOCIETY. 6oi)

OUR MILK SUPPLY AXD SOME OF ITS RELA-
TIOXS TO PUBLIC HEALTH.

BY TAIT BUTLER, STATE VETERINARIAN, RALEIGH, N. C.

In accei^ting the invitation of your Secretary, Dr. Lewis,
to read a paper at this meeting on the public or market milk
supply of the State, I did so with a distinct purpose in view.
It is perhaps telling no secret, and it is certainly not meant
offensively, if I state that the average practicing physician is
none too familiar with the real problems involved in putting
into the hands of consumers a wholesome milk supply. But
this, in my opinion, is not of great importance. It is not
necessary, however, desirable, that the physician possess ex-
pert dairy knowledge or that he be capable of performing tha
duties of a scientific dairy inspector. A much more important
matter, as affecting any effort for the improvement of our
milk supply, is that he have a full and accurate knowledge of
the real importance of pure milk for the consmnption of those
under his care.

Many of those here have given special study to this sub-
ject. Others who are investigators have full knowledge re-
garding certain phases of it, but the general practitioners
have not given that attention to the subject which its impor-
tance demands. Moreover, the general practitioner gets
closer to the public than any other man and it is through him
that the general public can be best reached ; therefore in this
paper I have decided to talk to the general practitioner and
to assume the part of an agitator rather than an educator.

All freely admit the importance of a wdiolesome milk sup-
ply as a general proposition, but how many know fully and
accurately the awful results of our criminal neglect in the
past along this line? How many have an accurate knowledge
of the quality, or lack of quality, of the milk now being sold
throughout the State ? How many realize the full measure

336 FIFTY-FIFTH ANNUAL, SESSION

of filth which it carries and what that means in misery and
death to the innocent babes who must consume it 'i

Gentlemen, it is not the ravings of a fanatic nor the ex-
travagance of a sensationalist, but a consei^v^ative statement
of terribly serious facts when I say to you that the almost
total ignorance of dairy science on the part of our milk pro-
ducers, the lack of knowledge of what constitutes first-class
milk and the care it should receive on the part of consumers,
and the almost criminal indifference and inertia of the medi-
cal profession who are the accepted guardians of the public
health are seeds, the awful but legitimate harvest of which are
ill health, misery and death to hundreds upon hundreds of
innocent consumers during our long hot summers.

The indifference of the public generally, and the indiffer-
ence and inactivity of the medical profession in particular,
along the lines of milk and meat inspection, are little short of
tragic and I wish I might say something that would help, in
a small way at least, to arouse and increase interest in this
long-neglected branch of sanitation.

There are three general ways in which the milk supply
may have a direct relation to the public health :

1. It may be a means of carrying and transmitting disease
from man to man, such for instance as typhoid fever, diph-
theria, scarlet fever, cholera, etc. ; but of these phases of our
subject I shall take for granted vou are better informed than
I, and omit their discussion.

2. Milk may be a means of carrying and transmitting dis-
ease from cows to man, such as tuberculosis, anthrax, foot
and mouth disease, cowpox, etc. Of these one alone is com-
mon, tuberculosis, of w^hich I shall have something to say
later.

3. Milk may cause disease in man by conveying disease-
producing agents or materials, such as filth and the conditions
which it favors for the growth of bacteria and the develop-
ment of toxins and other deleterious substances, also the pro-
ducts of mammitis and other septic troubles.

N. C. MEDICAL SOCIETY. 337

Of the distinct diseases affecting the cow, which also affect
man and which may be commmiicated from one to the other,
tuberculosis is of first importance.

When Koch discovered the bacillus of tuberculosis and pro-
claimed the identity of bovine and human tuberculosis, there
was little hesitancy in accepting a conclusion so closely in
harmony with the experience and observation of scientific
workers in both human and veterinary medicine. Later in-
vestigators called attention to the ditficulty in transmitting
human tuberculosis to bovines, and still later the fact was
pointed out that the bacilli from bovine and human sources
often possessed morphological and cultural peculiarities suffi-
cient to differentiate them; but when Koch followed, in 1901,
with the remarkable declaration that bovine and human tu-
berculosis were different and not intercommunicablc, few
scientific investigators were willing to accept the dictum on
the insufficient evidence produced, and at once investigations
were started all over the civilized world to determine the triith
or falsity of Koch's declaration. In the meantime progress
towards preventing the communication of bovine tuberculosis
to man received a decided setback.

The results of the investigations stimulated by Koch's
dogma indicate as clearly as the nature of the case will permit
that bovine tuberculosis may be and is communicated to
man.

It has been shown that the bacillus from human tuberculo-
sis is capable of producing tuberculosis in many animals, but
for no animal, unless man is the sole exception, is it so viru-
lent as the bovine germ. If the bovine bacillus is more viru-
lent for all other animals, including monkeys and apes, it
very logically follows that it probably is also more virulent
for man than the human bacillus.

Of course Koch has not recanted. He still maintains the
position taken in 1901, but the fact is now pretty generally
recognized that bovine tuberculosis may be a source of danger
to man.

338 FIFTY-FIFTH ANNUAL SESSION

The next question to arise "vvas naturally to what extent is
bovine tuberculosis a source of infection to man ?

In their efforts to show that bovine tuberculosis was rarely
communicated to man the fact of the greater frequency of
pulmonary than abdominal tuberculosis was pointed out, and
the claim that intestinal tuberculosis of children, the greatest
consumers of milk, was rare, were made much of.

Recently much evidence has been developed showing that
intestinal or abdominal tuberculosis of children is not so rare
as claimed by those who maintain that bovine and human
tuberculosis are not intercommunicable.

And still further, to the dismay of those who cling to old
beliefs because they are old, even the time-honored assump-
tion that the chief mode of entrance of the infection agent is
through the inhalation of germ-laden dust particles, has been
challenged and met with an array of facts and reason which
may well receive serious consideration by all those interested
in the question of the relation of the milk supply to the pub-
lic health.

It has been clearly shown that the introduction of the ba-
cillus into any part of the body, blood vessels, intestines, al>
dominal cavity or even a part so remote as the tail of the cow,
is generally followed by thoracic tuberculosis instead of neces-
sarily tuberculosis at the point of entrance or of near by
organs.

Again, when tuberculosis of the intestines is found, es-
pecially in children, the bovine germ, which may be recog-
nized, is frequently found in these cases of human tubercu-
losis. Is this not more than passing strange if the bovine
germ does not produce tuberculosis in the human ?

In short, recent investigations show plainly that not only
is bovine tuberculosis communicated to man, but that this is
probably not so uncommon as the comparative infrequency of
abdominal tuberculosis was thought to indicate.

To question the old inhalation theory of the entrance of
the tubercle germ from s]iutum pulverized is, I know full

N. C. MEDICAL SOCIETY. 339

well among the medical men here, likely to lessen the respect
which you will have for the other statements I may make,
but I can not resist the temptation to state that it never did
have any scientific evidence worthy of consideration to sup-
port it.

It is an old, well-known fact, that drying and sunlight
rapidly kill tubercle bacilli. One hour of sunlight will kill
tubercle bacilli in transparent layers of sputum, while five
hours exposure to sunlight will kill the bacilli in thick opaque
layers. Sputum is mixed with mucous, is tenacious and
hard to pulverize unless thoroughly dried. Yet we accept
the statement that tubercle bacilli resist this drying and pul-
verizing process to such an extent that this way, and this way
almost exclusively, is tuberculosis thought to be introduced
into the human system. The theory is not only not supported
by facts, but is most unreasonable. Furthermore, if the
tubercle germs enter by way of the air-cells, why is it that
tuberculosis starts in the capillaries instead of in the air-
cells ? Why is it that tuberculosis starts in the apex of the
lung, where there is a smaller proportion of air-cells, than
in the base of the lungs ?

Another discovery has recently been made ; namely, that
probably before the tubercle bacilli are expelled from the
body in any considerable numbers through other channels,
they may exist in large numbers in the manure. Years ago
I remember reading in Iv'ovy's "Laboratory Work in Bacteri-
ology" that there was a bacillus frequently found in cow ma-
nure that stained like the tubercle bacillus — very much like
it indeed, because it probably was the tuljercle bacillus.

ISTow, the chief filth in milk is cow manure. That cowy
odor is usually plain, vulgar filthy cow dung.

In the face of these facts what is our position ? We know
that tuberculosis exists in our daiiw herds ; we know that when
tuberculosis exists in a herd, owing to the passage of the ba-
cilli through the udder and through the intestines and ma-
nure, which almost always contaminates the milk more or

340 FIFTY-FIFTH AN^STUAL SESSION

less, milk from such a herd is almost certain to contain tu-
bercle germs; we know that infants, the largest consumers
of milk, have intestinal tuberculosis more frequently than
adults, and that the bacillus causing this disease is frequently
of the bovine type ; in short, we know that onr neglect to ex-
clude tuberculosis cows from our herds is causing the death
of many human beings, and yet we are doing nothing, literally
nothing, to prove ourselves worthy the title of guardans of
the public health.

The tuberculin test is the only means of detecting tubercu-
losis before the products of the cow are likely to be infective,
but we are not forcing the dairymen of the State to do w^hat
is to their own financial interest to do — test their cattle and
exclude the tuberculous animals.

Tuberculosis is not over-common in this State except in
the dairy herds, and is not as prevalent there as in many
States ; but it will steadily increase unless controlled. More-
over, if we admit its existence even, and the possibility of its
communication to the consumer of milk, we have no right to
stand idly by and permit any human being to take that chance
no matter how small the chance may be.

In my opinion diseases of the udder, and those conditions
of milk included under the general term ''filthy," are the
most fruitful source of injurious effects upon the consumers
of milk. All forms of garget, mammitis, or other diseases
resulting in pus and other inflammatory products entering
the milk, are unquestionably the source of much of the diar-
rhoeal troubles of infants resulting from the consumption of
impure milk. Filth, manure from the cow^s and stables, which
is the most abundant and common contaminating material of
unclean milk, has not in my opinion been given its full share
of responsibility for the high death rate from diarrhoeal dis-
eases so fatal to young children. Especially is this so in
North Carolina.

In short, tuberculosis, diseased udders and filth are the
three main sources of danger to the consumers of milk in this
State.

N. C. MEDICAL SOCIETY. 341

How are these conditions to be corrected ? In the first
phice clean milk is worth more than dirty milk, and it costs
more to produce it. Are our people willing to pay for clean
milk i I believe we are now paying a price, eight to ten cents
a quart, which entitles us to a fairly good quality of milk. If
this is not enough to enable the producers to put clean milk
on the market, then you, the guardians of the public health,
must educate the public up to the point where it will pay for
good milk.

In the second place, few of our dairymen know sufficient
of dairy science and practice to enable them unassisted to put
clean milk on the market. The general supply of milk can
be imj^roved, but for many years yet can not be brought up
to the standard necessary for the feeding of infants and sick
peojjle. Comparatively few men anywhere are able to put
such a quality of milk on the market. ^Miat is to be done ?

First, start here to-day such a campaign for pure milk as
will arouse public opinion, stimulate dairymen to gTcater
efforts and result in a competent milk inspection and super-
vision in every town of 3,000 population in the State. This
can be done and wall improve the general condition of the
milk supply. In every town where the demand wall justify
let a certified milk commission be established to encourage
some one or more men to produce and put upon the market a
first-class milk product. And last, as a temporary and doubt-
ful expedient, if filthy milk must still be consumed by many,
establish, under municipal control, where conditions render it
practicable, a pasteurizing plant where all milk below a cer-
tain standard must be pasteurized before being sold. Pasteur-
izing will not make unclean milk clean, but it may lessen its
injurious effects. If generally adopted it is likely to encour-
age filthy practices rather than correct them. It probably
lessens the digestibility of the milk and is only advisable as
the lesser of two evils. As between reasonably clean milk
and pasteurized milk there is no question in my mind of the
superiority of the former ; but if it is still necessary to put

342 FIFTY-FIFTH ANNUAL SESSION

up with dirty milk then, by all means, pasteurize. The chief
objection to it is that its use is likely to prevent as great an
effort to secure clean milk as would be made were pasteur-
izing not practiced.

How is the general quality of the milk supply to be im-
proved ?

First, by a proper system of inspection. Three forms of
knowledge are requisite for competent milk inspection. First,
a knowledge of cows in health and disease, possessed by the
veterinarian; second, a knowledge of dairy science and prac-
tice which should be possessed by the so-called practical
dairyman, but in our State rarely is ; third, a knowledge of
milk, bactcriologically, chemically and microscopically.

The milk inspection of a municipality may well be admin-
istered by a milk commission ; but if so, it should be made up
of men chosen for their knowledge of the work. For such
a physician a practical dairyman and a veterinarian are logi-
cally competent men. Or the administrative part of the work
may be left to the city health officer, but the success and effi-
ciency of any system of milk inspection depends on the effi-
ciency of the inspector and the quality of the laboratory work
done.

First there should be a frequent and thorough veterinary
inspection of the cattle. The inspector should also be a prac-
tical scientific dairyman Avho has had experience in dairying.
If it is claimed that such a man can not be employed then
the milk inspection will fall short of a full success just to the
extent that the inspector falls short of these requirements.

Our dairymen are hot desirous of putting filthy milk on
the market, but they don't know. The inspector must be able
to teach and lead rather than try to force rapid changes.

In most instances too much importance or reliance is
placed on laboratory examinations. These are essential, but
they will not take the place of frequent and competent inspec-
tions of the dairies and the manner of handling the milk.
Bacteriological examinations should be made for unquestion-

]S'. C. MEDICAL SOCIETY. 343

ably a high bacterial content is indicative of a high filth con-
tent. If there be a high bacterial content then the inspector
mnst seek the cause and correct it. He must have accurate
dairy knowledge and practical experience to do this.

A microscopic examination may be made, for a high leu-
cocyte and streptococci content, with the presence of fibrin,
indicates inflammation of the udder, but this is of most value
when examinations are made of the milk of individual cow's.

In the city of Raleigh we have a so-called milk inspection
which is practically nothing more than a bacteriological ex-
amination and publicity of the results or findings. ]^o com-
petent inspector is employed, no tuberculin test is made of
the cattle, and a violation of the regulations does not usually
mean any sort of punishment, but with all this good has been
accomplished. For instance, in 1906, after a complete neg-
lect of duty for three months, the commission was forced to
make a pretense of doing its duty by public criticism through
the press, and from March 27th to April 27th, 1906, fifty
samples, the first taken after this period of neglect, gave
twenty Avith a bacterial count of over 1,000,000 per cc. From
March 27th to Aj^ril . ., 1907, fifty samples gave seven with
a bacterial count of over 1,000,000 per cc. From March
26th to April 28th, 1908, fifty samples gave eight with a
count of over 1,000,000. In September, 1905, ten samples
gave an average bacterial count of 1,111,500 per cc. In Sep-
tember, 1906, ten samples gave an average count of 846,000
per cc. In September, 1907, ten samples gave an average
count of 164,000 per cc. In August, 1906, twenty-three sam-
ples gave an average count of 2,570,000. In August, 1907,
nine samples gave an average count of 890,000 per cc.

An improvement, but what filth still exists ! Fancy, during
the months of March and April, milk from three to five hours
old in which sixteen per cent of the samples have from one
to two million bacteria to the cc !

A bacteriological examination of milk is of importance,
but its chief value is lost unless supplemented by and done
in cooperation with an intelligent dairy and cattle inspec-

344 FIFTY-FIFTH ANNUAL SESSION

tion. A high bacterial count means either age or filth and
large numbers of liquifiers mean in all probability filth ; and
where dairies are not of fairly good grade, dairy practice
rather than age influences most the bacterial count.

We must keep in mind that a healthy cow gives a whole-
some product of fairly uniform quality. If the milk is put
on the market in bad condition, or of greatly varying compo-
sition, it means bad dairy practice. Very frequently I hear
of this physician or that one who insists that the cow shall
receive no cotton seed meal, or no silage, or some other excel-
lent food is tabooed. I have heard of this sort of thing in our
city of Ealeigh, and yet our system of handling milk makes
it almost certain that the fat content of the milk from any
one dairy may vary from 2.5 per cent to 8 per cent.

This has actually occurred and is due to the fact that milk
is sold from a large can instead of being bottled at the dairy.
The faucet being at the bottom of the can and the cream ris-
ing to the top, the customers first served get the 2.5 per cent
milk, while the last get milk containing 8 per cent or 10 per
cent butter fat. N'o sort of feeding will produce a change
of over one-half of one per cent in the butter fat content ; in
fact, it is doubtful if any effect on the fat content can be reg-
ularly and consistently produced by any sort of feeding ; there-
fore, it will avail most to give more attention to the handling
of the milk for it will certainly mean discomfort if nothing
more serious to any delicate infant to receive 2.5 per cent
milk to-day and 8 per cent milk to-morrow.

Good milk will not be put on the market until the dairy-
man is required to bottle it at the dairy under proper sanitary
and dairy conditions.

Some of the points that need attention in our North Caio-
lina dairies are:

1. Test all cows with tuberculin and exclude the diseased
ones. The Korth Carolina State Department of AgTiculture
will do that free of charge on certain reasonable conditions

2. Institute an intelligent inspection of the cows and ex-
clude all those with any disease of the udder.

N. C. MEDICAL SOCIETY.

345

3. Prohibit the selling of milk except iu bottles, and re-
quire that the milk be kept below a certain temperature.

4. Prohibit feeding during or just before milking.

5. Compel dairymen to keep their cattle clean; cows can
be cleaned but milk can not.

6. Compel dairymen to wear clean clothes and wash their
hands before milking.

7. Wipe the udders off with a damp cloth and use a cov-
ered milk pail.

These can only be brought about by an inspection capable
of leading and teaching. We can not have entirely clean
milk at once, but we might have cleaner milk with an intelli-
gent effort.

As an illustration of how the cleanliness of milk is influ-
enced by dairy practice, as indicated by the l)acterial count, I
desire to present the following charts, the data for which have
been taken from Bulletins 'No. 42 and Xo. 48 of the Storrs.
Conn., Agricultural Experiment Station.

It has been stated as an excuse for the filthy milk which so
many of our dairymen are putting on the market that from'
lack of knowledge, capital, or other facilities, they could not
produce and put clean milk on the market. These charts
show that certain practices produced a wonderful improve-
ment in the quality of the milk, as indicated by the bacterial
count ; and yet all these things could be done by our dairy-
men. They are all simple, practicable and inexpensive.

Milked before Feeding

Milked after Feedino-

Diagram showing relative bacterial content of milk before
and after feeding hay and grain.

^lilked before Feeding

Milked after Feedim

Diagram showing relative bacterial content of milk drawn
before and after feeding drv corn stover.

346

FIFTY-FIFTH ANNUAL SESSION

Not Brushed
Brushed

Diagram showing relative bacterial content of milk drawn
immediately after the cows had been brushed and when
no brushing was done at that time.

Udders and Flanks Wiped

Udders and Flanks not Wiped

Diagram showing relative bacterial content of milk drawn
immediately after the udders and flanks of the cows had
been wiped with a damp cloth and when they were not
wiped.

Educated Milker

Eetiular Milkers

Diagram showing relative bacterial content of milk drawn
by an educated dairyman and that drawn by regular
milkers.

Covered Pail

Open Pail

Diagram showing relative bacterial content of milk drawn
into a Stadtnuieller covered pail and into an ordinary
open pail, in a dairy where extra care is given to cleanli-
ness.

Covered Pail
Open Pail

Diagram showing relative bacterial content of milk drawn
into a Stadtmueller covered pail and into an ordinary
pail in a dairy where considerable care is given to cleanli-
ness.

Covered Pail
Open Pail

Diagram showing relative bacterial content of milk drawn
into a Stadtmueller covered pail and into an ordinary
pail in a dairy where little care is given to cleanliness.

X. C. MEDICAL SOCIETY. 347

In all of the experiments furnishing the data upon which
these diagrams are based more than ordinary care was taken
to follow correct dairy practices. In all experiments, except
in the ones comparing open and covered jDails, the Stadt-
mueller covered pail was used, and all other conditions except
those being tested w^ere as near alike in all cases as it was pos-
sible to make them. In dairies where little regard is paid to
cleanliness the results would still more forcibly demonstrate
the effects which the methods of handling the milk have on its
cleanliness and the bacterial count.

348 FIFTY-FIFTH ANNUAL, SESSION

THE EELATIOK OF THE LABORATORY TO THE
GENERAL PRACTITIONER.

BY WATSON S. EANKIN, M.D.,

Dean Wake Forest College Medical School, Wake Forest, N. C.

Introductory.

Mr. President, Ladies and Gentlemen: — This subject as-
sumes the existence of two fields of work. In one we see doc-
tor, patient and the sick or operating room ; in the other we
see micro-chemist and laboratory.

To question the right of either to a place in the practice of
modern medicine would be analogous to questioning the right
of antiseptics to a place in our pharmacopoeia.

Since it is an unquestionable fact that the two are neces-
sities— nothing less — in the right practice of the healing art,
it behooves us to consider carefully and decide what the proper
relation of these two — micro-chemist and general practi-
tioner— is and should he to one another.

The Relation as It Is: That they are closely related there
can be no doubt. Blood-kin by both birth and destiny, born
of the same parent-need, yea born under the same stars, both
coming in response to the cry, groan or sigh, and both going
to its succor.

Although close in origin and destiny, betwixt the two their
paths too often diverge, and too seldom are they found travel-
ing the same path, too seldom do they lodge under the same
covering.

Xow, I believe it is a fact that few will deny, and none
successfully controvert, that these two naturally dependent
agencies have been rendered too artifically independent, an
independence whose cause is false pride, indifference or igno-
rance, and whose cost is human life. Who among you has not
heard the short-lived history of that chronic or persistent
bronchitis "that went into consumption," but required from

X. C. MEDICAL, SOCIETY. 349

three months to a year or more to make tlie trip, and on the
way sowed the seed of death into the house for other crops of
human organisms when the lirst one should follow the sower ?

^Yho has not heard of that imaginary hybrid, typho-
malaria, untreated by proper dietetic measures, until the cor-
rect diagnosis was first wi-it in a pool of blood flowing from
a relaxed sphincter ?

Who has not heard of the pale, stunted child so backward
at school, who improved a little on the doctor's iron and then
relapsed into its former self, run this course over and over
again, when all that was needed to save the bloom of life's
spring time for the fruit of life's summer was one dram of
thymol and two doses of Epsom salts ?

Most of these cases would not have occurred had there been
a better understanding, a more active cooperation between
the general practitioner and the laboratory.

Xow, accepting the above claim, to wit, that the general
practitioner and laboratory are met in that intimate relation
which would best subserve the happiness and lives of our
kind, it would logically be our next duty to inquire into the
cause of this pathological independence of these two great
systems of the medical organization.

Causes of Hurtful Separation: Xow, in the careful con-
sideration of this disease of the medical organization, to wit,
loss of coordination of two of its most important and depend-
ent systems, I am convinced that a faulty literature on the
subject plays a most important etiological role.

Xot faulty in its abundance, unless it appears to hide the
truth like hay the needle, but faulty, in that as a rule it has
treated this relation in a general way, treating it as the rela-
tion of laboratory to profession, apparently failing to recog-
nize or at least properly emphasize that the laboratory to be of
real value must be seen by the practitioner, not in its general
relation, hut in its relation to him, the individual, the unit of
the profession, through which it must pass to its more gen-
eral use and good.

350 FIFTY-FIFTH ANNUAL SESSION

Because this relation has been treated of in general terms,
the rules governing it are general rules and not specific rules.
General rules, dealing with the many, dividing responsibility
to a minute division, lose the force of specific rules.

Well defined, recognized rules are not only a guide in the
search for truth, but a propelling force, exactly parallel to
one's sense of duty.

One more defect in the literature dealing with this relation
and I pass to other causes : This last defect is an apparent
oversight of the various modifying factors that control access
to the laboratory.

Without discrimination all practitioners are supposed to
use the laboratory, w^hen their practices are as different in
many cases as is the mercantile business in the country cross-
roads store and the New York department store. A second
potent cause of this separation of micro-chemist and prac-
titioner is the latter's loss of confidence in the laboratory
report.

This lack of faith is partly his own fault, but for the most
part it is the fault of the laboratory. The practitioner errs
in expecting too much from the laboratory, in being disap-
pointed with frequent negative reports, apparently forget-
ting that the laboratory, like himself, is limited in the field
of diagnosis.

The micro-chemist too frequently errs in his zeal to give
satisfaction to retain a patronage undeserved, by giving the
practitioner what he wants — a diagnosis — but one which the
doctor's case subsequently proves was but a guess.

The Relation as It Should Be: This must be a relation
thoroughly understood and accepted by both parties con-
cerned, accepted not altogether as a matter of choice, but
perforce of the reasons on which this relation must be built
if it is ever established. Such an impregnable foundation
of reason can exist only when it takes into account the
various modifying factors controlling this relation. This
established relation is not likely to be the product of the
specialist.

K". C. MEDICAL SOCIETY. 351

We may look with more hope to the general practitioiierj
who started out with thorough laboratory training, or to the
laboratory man who onoe knew the task of the general prac-
titioner; in other words to those whose environment permits
them to see both fields of work. The specialist in internal
medicine with a train of young men greedy for his counsel
and influence and ever ready to do the technical part of his
laboratory work, and the salaried laboratory man in the en-
dowed laboratory A\dth nmnerous assistants, both alike are
preaching w^hat they do not and could not practice when th*^y
urge one man to labor in two fields of work. This perma-
nent relation established on unquestionable facts will take
note of the following conditions :

First. The practitioner who does not use the laboratory for
its diagnostic uses does not give to his patients what he is
due them, and what the medical profession affords them.

Second. That the pathological conditions present do not
always indicate laboratory assistance. The various indica-
tions for laboratory appeal as they arise in the multiple dis-
ease conditions, would lead me too far afield to include them
here. It is to be remembered, too, that until the State or
charity does this work, the laboratory is for many beyond
their financial reach, even though the pathological condition
calls for laboratory consultation.

Third. The method of obtaining laboratory aid will vary
with the individual practitioner. If the physician has tiuie,
training, and can afford to invest from one hundred and fifty
to two hundred dollars in apparatus, he should do this work
himself. The man especially well fitted to make this per-
sonal use of the laboratory is the young man just out of the
hospital and laboratory. The cost is nothing like the cost of
an electrical outfit, and in five years wdll have paid five dollars
where the more expensive investment has paid one. On the
other hand, if time, training, or apparatus is wanting, the
physician should have the work done by some one else. If
time is the factor in his way, if, as is usually the case, his

352 FIFTY-FIFTH ANNUAL SESSION"

practice does not leave him the time for this work, perhaps a
nurse or intelligent assistant may be trained to do much of
the technical part of this work, such as blood counting, filtra-
tion and titration stomach contents, testing sp. gT., reac-
tion, albumen, rough sugar and bile-test wine, with cen-
trifugalization and sediment collection, etc. If this is not
possible, certainly then it is the duty of the doctor to collect
and send to the nearest competent laboratory his material for
examination. Whenever there is doubt as to sending mate-
rial to the laboratory for examination, let the doctor be gov-
erned by the Golden Rule. I do not believe with the ma-
jority of writers on this subject, that these busy practitioners
should attempt this w^ork. For these men the time w^ould be
more profitably spent in reading, in mastering the indica-
tions for and the meaning of laboratory findings, and in keep-
ing pace with advancing medicine through the use of new
text-books and good journals. Instead of going off for special
courses in microscopy, let the busy man devote that time to
perfecting his physical diagnosis, perhaps adding to this im-
portant branch the use of the oplithalmoscope, laryngoscojie.
proctoscope, wrethroscope and spryginograph. These things
he must do on the field where he finds his patient or send his
patient to another. He can send his microscopic work away,
but retain his patient.

Is. C. MEDICAL SOCIETY. 353

OBSTETEIC WORK FROM THE STANDPOINT OF
THE GENERAL PRACTITIONER.

BY A. B. CEOOM, MAXTON, N. C.

This is a subject which should interest every medical man ;
for no section is without its share of such work, and to the
I'xneral practitioner or family physician usually falls theiie
duties.

Obstetrics, we all concede, is a line of our profession en-
tirely distinct and yet very closely connected Avith the general
])ractice of medicine. Still it is a line of work falling more
on the surgical than the medical side.

I desire in these brief remarks to emphasize the surgical
side and to point out or call attention to what the author
regards a few of the most important points to be remem-
bered in attending the usual run of lying-in cases.

1st. Remember that in complicated cases, when interfer-
ence is necessary that an experienced and skilled obstetrician
is required, and even when we feel ourselves thoroughly com-
petent to do the said skilled piece of work, that an assistant
should be called.

2d. Of still more importance is it to remember that nature
is the great obstetrician and will, in the majority of cases, be
able to pull the patient through without our "skilled assist-
ance" ; therefore do not interfere unnecessarily — do not be
guilty of "meddlesome midwifery."

3d. Remember that from start to finish in any labor case
there is nothing of more importance than asepsis. Here I
may remark that while I am well aware that some of my
friends regard this a matter of choice or some might say
useless and unnecessary; still I wish to lay especial stre-^s
upon the use of sterile rubber gloves as a routine. It has
been a great satisfaction to me in my few years experience
to feel sure when finding a slight rise of temperature that it
23

354 FIFTY-FIFTH ANNUAL, SESSION

could not be any infection coming from improper cleaning
of my hands.

It is of course the duty of one who announces himself in
this line of work to be ready to promptly meet all emergen-
cies. The obstetric bag should be kept in thorough readiness.
It should contain the usual articles as sterile gauze, cotton,
perineal pads, nail brush, soap, bichloride tablets, and, in
addition, such instruments as forceps, needles, silk or other
suture material, etc.

In event of a tear of the perineum or cervix they should
be immediately repaired. And before such repairs can be
done they must first be found ; therefore, do not fail to look
carefully.

Preparations are made for care of the baby before the
rush, and means of resuscitation should be at hand always —
hot and cold water, a flannel wrap for the child, etc.

Post-partum hemorrhage should always be thought of in
time to avoid it. The bladder and rectum should be emptied
at the beginning of labor. Quick and vigorous kneading of
the uterus as soon as the second stage is past should be con-
tinued through the third stage, and further, until the contrac-
tion is firm and a hard uterus is felt. A routine dose of
ergot after the placenta is delivered is my practice. It may
save trouble and can not do harm.

The after treatment of these cases is of importance. The
duty of the attending obstetrician is by no means done wht-n
his patient is safely delivered and comfortable.

Perineal pads should be applied immediately after the
patient is cleaned up and before any change of clothing and
bedding. These should be used during the entire puerperal
period and changed as frequently as indicated — each few
hours during the first day or two — and thereafter as neces-
sary, two or three times daily. The patient should be kept
quietly and comfortably in bed, not remaining in any one
position long enough to allow a slight displacement to give
trouble in the future. The diet should be regulated largely

N. C. MEDICAL SOCIETY. 355

by the condition of the patient — the breasts or rather the
milk supply being the chief index. If the milk is scanty, a
liquid diet — cocoa, tea, milk, etc. If abundant, and breasts
are giving pain, a dry diet is indicated.

The most normal cases should remain in bed for ten (10)
days and should not show the least rise of temperature.

The practice of giving a saline or castor oil purge on the
second day is a good one and often saves a slight rise of a
half or one degree in the temperature. A rise should be re-
garded with suspicion, and if the odor of the lochia indicates
the least trouble, especially if we have a chill, intra-uterine
douches of hot saline solution should be promptly and fre-
quently employed until all temperature and odor are gone.

With proper technique we should not have any run of tem-
perature, and the patient may be dismissed on the tenth
day.

356 FIFTY-FIFTH ANNUAL SESSION

THE RELATIOX OF THE OPTHALMOLOGIST TO
THE GEIsTERAL PRACTITIOI^ER.

BY GAILLAED S. TENNANT, M.D., ASHBVILLE, N. C.

In striving to throw out some aids to the general prac-
titioner in picking out those cases whose welfare may demand
the specialist's attention, it will he necessary, first of all, to
attempt some loose classification, hoth as to physician and
patients.

In the first place, the physician who does not understand
and practice the use of oblique illumination with a two or
three-inch focus lens in examining his eye patients belongs to
a separate class. When he attempts to diagnose eye diseases
he places himself in the same class with the man who would
diagnose lung troubles without the use of auscultation or per-
cussion. He may be able to diagnose an ordinary squint ; he
may sometimes find foreign bodies, but he can not tell when
he has removed them; he may diagnose gonorrhoeal opthal-
mia, but he can not treat it intelligently ; he may be reason-
ably sure of his diagTiosis of simple catarrhal conjunctivitis
if it is prevalent. In short, his sphere of active usefulness
is very limited, and his plain duty, if his field is far removed
from a specialist, is to procure an ordinary convex lens of
1 1-2 or 2-inch diameter and 2 or 3-inch focus, and, bearing
in mind a little local anatomy, see how much it will reveal
in a moderately darkened room aided by a common lamp and
a little practice.

To another class in need of some suggestions belongs the
physician who refers many of his cases to the optician. A
good plan for him to follow would be to close up his office
and only attend to his very ill patients, referring his office
patients to the druggist. The great majority of the profes-
sion, however, are familiar enough with the commoner forms
of eye trouble to diagnose them correctly with what means

N. C. MEDICAL SOCIETY. 357

they have at hand, and understand the fundamental rules of
ocular pathology well enough to catch the import of the dan-
ger signals in its connection. Their mistakes are generally
errors of judginent, and to encourage the cultivation of this
quality by men of this stamp is the aim of the remarks fol-
lowing.

It will be necessary to modify most of the suggestions in
accordance with the distance from a competent oculist or other
difficulties in the way of special assistance.

As to classification of patients, nearly all the cases referred
to the specialist belong in one or the other of these classes:
(1) Those needing special care or treatment; (2) those re-
ferred for aid in or confirmation of diagnosis or prognosis in
some general disease or injury.

In this connection it would be well for many, especially
those at a distance, to bear in mind that there is usually a
clearly defined line between these two classes, which should
be explained to patients of the latter class, who often expect
some direct benefit to result from an examination, in place
of regarding it as but a means to an often remote benefit.

In discussing the first class of cases many of the commoner
diseases will be taken up and the salient points dwelt upon
where the work of the general practitioner and the specialist
seem to come together.

Lids and Lachrymal Apparatus. — Styes, the commonest of
the lid affections, can often be aborted; but when they have
developed every one should know where and how to open them.
It should be borne in mind that successive crops of styes in an
otherwise healthy person are indicative of eye strain or some
other local irritation. Lid tumors may be removed success-
fully by any one who understands their thorough extirpation
by dissection or curettage — from the inside of the lid and not
through the cutaneous surface, as is sometimes done.

Lachrymal abscess may be temporarily relieved by any
one, but its sequelse are so persistent that the profession gen-

358 FIFTY-FIFTH ANNUAL SESSION

erally considers it a privilege to shove the case off on any one
who will take it. Any interference with the proper drainage
of the tears is serious, and though some cases of stenosis of
the caniliculus yield quickly to dilatation, permanent relief
generally requires from one to two months of constant treat-
ment, and from three to five months of intermittent treat-
ment.

There are always many of these sufferers remote from the
specialist who could be cured by the local man of surgical
instincts.

Conjunctiva. — The treatment of the milder forms of con-
junctivitis is of course optional with the physician, especially
during an epidemic, but not unless he is prepared to say that
there is not a minute foreign body present or an incipient
iritis. Too often a painless iritis is mistaken for conjuncti-
vitis until permanent adhesions have formed with disastrous
results. Purulent opthalmia, both in the new-born babe and
the adult, is so dangerous that a suspicion of its presence
should call for immediate and close attention. Its proper
treatment entails a constant watchfulness and delicacy of
manipulation that should properly be shared with or turned
over to the specialist along with the responsibility for the
uncertain results.

Cornea. — It is hardly saying too much to state that all
affections of the cornea should belong exclusively to the prov-
ince of the specialist. It is unique in its structure, its physi-
ology and its pathology. Its complex circulation, innerva-
tion and functions make of it a lifelong study, and nothing
in the realm of medicine is more gratifying than the success-
ful results attending wide experience in treating the various
forms of keratitis and the many varieties of corneal ulcer.
On the contrary, nothing is more disheartening than the in-
tractibility of these same conditions in inexperienced hands.
It should be borne in mind that while in most corneal dis-
eases the danger is not great, there are certain infectious pro-

N. C. MEDICAL SOCIETY. 359

cesses which act rapidly and fatally as to sight if not properly
handled.

Iris. — Every physician should be able to diagnose iritis,
and at least take the first steps toward preventing the evil
effects sure to follo^v every neglected case. Too often the
sufferer only falls into competent hands after permanent ad-
hesions have formed, and the disease extended backward
through the uveal tract. He should look in every suspicious
case for the three danger signals: the sluggish or immobile
pupil, the discolored iris and the temporo-frontal pain; and
finding them, or one of them, should either immediately be-
gin active treatment or refer the case to the specialist. He
should remember, too, that the painless cases are generally
the most far-reaching in their consequences.

Lens. — The patient with cataract should of course be sent
to the specialist, though not necessarily to a distant city. Let
the local eye man at least tell him whether or not it be ripe.

Diseases of the Retina, Choroid and Optic Nerve may be
passed over. Mention should be made, though, of the im-
portance and success of early and radical treatment in many
of these conditions, especially in the neuritis from tobacco,
alcohol or other poisons.

Injuries, Wounds and Foreign Bodies. — All injuries of
the eyeball should be referred to the most competent man
at the earliest moment, it being impossible for the average
physician to bear in mind the numerous little points on which
the preservation of the sight may depend. Especially is this
true of wounds made with splinters of wood and the like, and
of imbedded foreign bodies, where examination with a two-
inch loup is imperative. Without the use of the loup no one
can be certain of the complete removal of foreign particles
no matter how simple it may seem.

Functional Derangements and Their Reflex Symptonis. —
On this threadbare topic it is hard to say anything new or
attractive, yet it is the most important division of the sub-
ject and should not be slighted. Eye-strain has been pa-

360 FIFTY-FIFTH AI^NUAL SESSION

raded, chained to the chariot of many an advertising- hero
this score of years as the cause of every ill connected with
the nervous system, whether wrongfully or not, it were idle
to discuss in a general way. Suffice it to say that it is so inti-
mately connected with most cases of neurasthenia that no
careful and thorough worker should overlook it in unraveling
the vague and tangled symptoms of the neurotic.

In the case of headaches the connection is usually obvious,
though the manifestations are various, as the following
hasty attempt at classification will show: (1) Temporo-
frontal headaches, coming on immediately after excessive
or even ordinary use of the eyes, and usually subsiding after
short rest; (2) ill-defined, general headache, coming on in
the same way but of irregular duration; (3) the headache
that lasts the whole of the next day after some unusually
close application; (4) general headache, appearing at a regTi-
lar time each day, be it morning, noon or night, and lasting
several hours; (5) the dull ache that continues day and night
through weeks or months; (6) pain and soreness in the occip-
ital and cervical regions, generally persistent; (7) headaches
at night after a day spent in travel or some unusual occupa-
tion; (S) a condition occasionally seen in which the pain
is as sudden, as severe and as persistent as that of meningeal
origin.

Presenting as they do this diversity, it Avill be seen that
eye headaches are not always easy to pick out. The habitual
sufferer should be carefully examined, grave disorders elimi-
nated, digestive and excretory functions looked into, and all
sources of so-called neuralgic pain sought for ; these failing,
the case is one for the oculist, and the result, if time and care
enough be given to the task, will usually be the finding of
some defect to account for the trouble. Headaches from ca-
tarrhal involvement of the accessory sinuses closely resemble
some of the above, but are fortunately rare.

Periodic headaches of the mijraine type are sometimes
found in which eye-strain plays an important if secondary
role.

N. C. MEDICAL SOCIETY. 361

111 order to prove the connection in cases of constant or
daily suffering the following plan has been found valuable
to those at a distance from the specialist : Atropin is instilled
daily, and if the trouble is due in any measure to the eyes
some relief or even total relief will come in from two to four-
teen days. Proper precautions against exposure to bright
light must be taken or the test is worthless. Xor should one
fail to sound the old warning as to the development of glau-
comatous symptoms. If relieved, the patient should be sent
to the oculist at once to save further application of the cyclo-
plegic for the determination of correctible errors.

A certain ill defined and persistent nausea seems to be al-
most as directly dependent on the eye-strain as headache.

The family physician and the specialist should consult
together oftener, especially in the corneal affections of child-
hood, and in all cases of known or suspected syphilistic
origin ; in other w^ords, wherever heredity comes into play
and where active and far-reaching medication is to be un-
dertaken, a knowledge of family weaknesses is of vital im-
portance in treating children ; and in beginning specific
treatment in the adult the specialist is apt to use heroic
measures unless warned of some contra-indication ; then, too,
the victim of syphilis should not be left to himself as soon
as his eye symptoms subside.

Turning now to those cases where an examination of the
eye and its functions may reveal some points of diagnostic
or prognostic value, irrespective of the presence of ocular
symptoms, be they mild or grave, a wade field opens up.
Broadly speaking, in every chronic disease and many acute
ones in which the blood pressure or vessels may be affected to
the point of leakage, thrombus or embolism, these processes
are apt to take place in the retina where their presence can
be immediately detected and their progress closely watched.
In arterio-sclerosis, of whatever origin, in fatty degeneration,
diabetes and all forms of kidney disease, these symptoms
may be of particular value. I^ot infrequently the presence

362 FIFTY-FIFTH ANNUAL SESSION

of one of these maladies is first discovered in the course of an
opthalmic examination ; and, while the microscope has largely
displaced other methods in the diagnosis of Bright's disease,
still in many cases the nature and probable course of the dis-
ease can be made out with the opthalmoscope.

So intimately connected are most forms of disease of the
brain and nervous system with various ocular phenomena
that the neurologist or he who would intelligently treat any
serious nervous disease, be it organic or functional, must
either be able himself to correctly test the eye reflexes and
muscles, and map out the field of vision, or else have some
one at hand who can do it for him.

In tabes and multiple sclerosis, diagnosis as well as prog-
nosis may depend on the eye symptoms, while some cases of
hysteria defy every examination but that of the visual field.

In every case of suspected brain tumor the same tests must
be applied at the earliest moment, for many minute growths
can be positively located ; whereas, later the general pressure
due to their size or long standing obscures all other symp-
toms.

In injuries and suspected fractures this state of affairs,
engorgement of retinal vessels or choked disc, often obscures
absolute location, though sometimes paresis of a single muscle
or group of ocular muscles or defect in the field of vision
may point to the exact seat and nature of the injury.

In conclusion the writer would enter a plea for a closer
relationship and understanding between physician and op-
thalmologist in all cases. A common experience illustrates
the need of this cooperation. For instance, a patient begin-
ning to suffer from the eye trouble dependent on a facial
paralysis is referred to the specialist without any further
instructions than that he have something done for his eye.
In this case all three parties concerned are at sea in separate
boats, out of hailing distance, and much time and energy are
lost in bringing them together.

N. C. MEDICAL SOCIETY. 363

AN OPINION AS TO THE ULTIMATE EESULTS OB-
TAINED FEOM SURGICAL, IN COMPARISON

' WITH MEDICAL TREATMENT, IN CERTAIN
OVx\RIAN DISEASES AND IN ALL OVARIAN

NEUROSES.

BY J. ALLISON HODGES, M.D.,

Physician-in-charge of the Hygela Hospital, and Professor of Nervous and Mental
Diseases, University College of Medicine, Richmond, Va.

The best method for the treatment of ovarian diseases and
neuroses is, and always has been, a problem for the profes-
sion.

I am in no sense an opponent of discriminating and skilled
surgery in these cases, nor do I decry the brilliant results
often obtained; but an experience of a number of years in
the treatment of this class of patients, coming to me in the
various stages of the acute and chronic manifestations, and
coming, also, from the hands of many of the most brilliant
operators in this country, have convinced me that surgery
has been overrated in their cure, and that, unless there is a
marked pathological condition of degeneration or destruc-
tion, this line of treatment has been largely unavailing and
impotent, and that medical lines of treatment, vs^hen proper
discrimination has been used and careful regimen carried
out, produce the best results.

To speak plainly, I believe that specialism has rim mad, and
the further fact that therapeutic nihilism prevails in the
minds of many physicians and surgeons, has often been the
precipitate cause of surgical intervention in many of these
cases, which should have had the benefit, certainly, of more
careful, more systematic and more enthusiastic medical treat-
ment before being submitted to surgery as a ^'dernier resort"

It is my opinion that for a proper diagnosis and conse-
quent successful treatment this class of cases requires more
knowledge of the fundamental principles of the basic ele-

364 FIFTY-riFTH ANNUAL SESSION

merits of medical and surgical science than almost any other,
and that success can not even be hoped for unless each case
is considered upon its special and individual merits.

It is a mistake to enter upon their treatment believing that
nothing will avail short of surgery, which often is the despair
of curative medicine. Medical men have usually been more
dilatory, or at least more modest, than the surgeons in ad-
vancing their views and advocating their claims, and the re-
sult has been obvious.

It is likev/ise a fact that the surgical method of treatment
frequently appears to be an excuse for lack of interest, indus-
try and discriminating intelligence on the part of the phy-
sician, and that it often appeals to us as an easy method of
getting ourselves out of a perplexing situation.

Most medical men are not fully-rounded physicians and
surgeons, and it is equally true that most surgeons are not
fully equipped in the whole realm of medicine, consequently
errors of judgment in treatment are as easy as errors in diag-
nosis.

Oftentimes surgeons are not fitted by practice to study the
medical side of a case, or are too prone to ignore the medical
points in evidence, just as the physician is often ignorant or
unpracticed in the surgical features of such cases.

In other words, there is frequently a lack of skilled knowl-
edge in diagnosis on both sides, and the prevalent idea in our
profession, both medically and surgically speaking, that the
correction or removal of some one abnormality will solve the
difficulty, is the basis of many of the undesirable results seen
in these cases. I have not tabulated any series of cases for
this paper, for, while the list might be startling, it would not
be conclusive nor convincing to many who have not personally
examined them and made their own diagnoses.

It is my belief that too little attention has been given to
the scientific and clinical study of the individual cases by
both physicians and surgeons, and that a grave mistake is
frequently made in submitting the patient to the surgical

N. C. MEDICAL SOCIETY. 365

procedure too early, for the fact is often and deplorably over-
looked that the surgical operation, especially if unsuccessful,
robs the poor patient of the last despairing hope of healtn.

The realization of this by many patients, particularly
those of a neurotic temperament, removes all hope or effort,
and induces a resultant train of nervous and mental symp-
toms compared to which the former state of chronic invalid-
ism was but a trifle.

In brief, then, the successful treatment of these cases re-
quires not only a complete and continuous medical and surgi-
cal study of the special symptoms, but also of the individual
temperament of each patient, as well as a hopeful and enthu-
siastic spirit of management in a carefully planned and well-
developed line of treatment, exhausting every means at hand
for the alleviation of physical suffering before submitting
the patient to the alternative of surgery, unless there be
marked evidences of a pathological condition urgently re-
quiring it.

I am aware that many of these patients fade away, carrying
along with them the reputation of the physician and the silent
evidences of his lack of discrimination ; but still I believe that
if the physician could impress his patients with the fact that,
although they are able to be on their feet, they have symp-
toms of an illness which is just as definite and just as logical
as would be the evident signs and symptoms of a pneumonia,
for instance, and that, though their symptoms are different
from the usual signs and symptoms of illness, still that, if
these patients w^ould consent to be guided by the careful ad-
vice and treatment of their physician, the ultimate results
v;ould be as beneficial and lasting as in the commoner forms
of disease.

In my opinion we, as physicians, are to blame for not im-
pressing, and gravely impressing, these patients with the
seriousness of their condition, and not insisting upon the en-
forcement of our directions and the necessity of the patient's
full cooperation.

366 FIFTY-FIFTH ANNUAL. SESSION

If the physician be lazy, or too little interested to properly
manage the case, it would be better for himself and far bet-
ter for the patient that he should not in any manner attempt
its treatment.

I believe further that with a proper appreciation of these
facts by the physician and a considerate cooperation from the
patient, we could in most of these cases produce results that
would be as brilliant as ever could be accomplished, in occa-
sional cases, by means of surgery.

Meddlesome pelvic interference by the physician in the
treatment of these cases is no less to be countenanced than
precipitate surgical intervention by the surgeon, for I believe
that he is a wise man who, recognizing an oophoritis, will
allow the uterus, for example, no matter how greatly displaced
it may be, to remain just as he happens to find it, and will
address himself to the ovary alone.

Relieve the patient first of her intolerable suffering and
despondency, thus securing her sincere regard and cooper-
ation, and there will be time enough left to rectify other mat-
ters.

I do not believe that the cause of the long and varying train
of symptoms referable to ovarian disease is usually found
within the uterus, however misplaced it may be or in how-
ever great a degree its mucous membrane has degenerated,
for it seems to me to have been frequently demonstrated that
a retro-displacement and oophoritis are entirely distinct
troubles, each characterized by peculiar phenomena, and each
calling for separate treatment.

I have found pessaries to be only exceptionally beneficial,
and more often that their indiscriminate use and not infre-
quent maladjustment have been the exciting cause of serious
disease.

I do believe, however, that in prolapse of the ovary, in
hyperaemia or congestion, in oophoritis, acute and chronic,
as well as in oophoralgia and ovarian neuroses, great and
lasting- benefit has been obtained along medical and hygienic
lines of treatment.

N. C. MEDICAL SOCIETY. 367

Absolute rest, full feeding, proper eliminative measures,
hot vaginal douchiugs, not pints, but gallons, medicated tam-
pons of icthyol-glycerin, painting the vaginal vault with
iodine, repeated small fly blisters to the iliac region, the use
of the galvanic current of about fifty milli-amperes, massage,
unless blood or pus has accumulated in the Fallopian tube,
where, of course, this measure is contra-indicated, as there is
danger of fluid being pressed into the peritoneal cavity, gradu-
ated gymnastics, etc., together with the administration of
tonics, the very careful use of nervines, the chloride of gold,
the daily use of three to six tablets of the desicated parotid
gland substance of sheep, systematic hydro-therapeutic ap-
plications, etc., are all in turn and as required potent agencies
for palliation as well as cure.

In conclusion, my experience has taught me, and this paper
is intended not as a dogmatic presentation of the subject,
but simply as a record of my personal experience, that both
physicians and surgeons do not frequently appreciate the
medical and psychic treatment and management of these
(rases, for in most instances, except with the qualifications
stated above, the surgical treatment in the end produces no
better results than the medical, and often robs the patient
of the last hope, leaving her a physical and mental wreck,
even if cured, so to speak, anatomically. This result is wholly
disappointing, and is only changing the clinical picture of
the disease, substituting oftentimes for painful manifesta-
tions those symptoms resulting from a morbid hopelessness
for relief, the last stage being worse than the former.

In some few cases nothing but an operation will cure the
patient, and when, after careful treatment and discriminating
study of the case, such a fact is recognized, it is nothing
short of ignorance or prejudice to deny the patient the benefit
of an operation for possible cure ; but even the surgeon, in
his work, should be guided by the rules of the strictest con-
servatism, and should not forget, as is so often done, that the
cure is not completed when the uterus or ovary is replaced

368 FIFTY-FIFTH ANNUAL SESSION

or extirpated, but that to accomplish the best results and to
avoid as well the recurrence of habit symptoms medicinal
agencies must be called into requisition.

Only in this way, then, by medical lines of treatment at
first, fully and faithfully administered, afterwards by surgi-
cal methods, if the former have proved futile, and by both,
if the latter become necessary, can the end aimed at, complete
restoration to health, be obtained.

To summarize, I believe that (1) too little time and skill
are usually expended by both physicians and surgeons in the
proper diagnosis of these cases; (2) the proper diagnosis re-
quires a critical consideration, not only of the pathological
conditions present, but also of the individual temperament
of the patient in question; (3) each case must be considered
uj^on its special and individual merits, and it must be re-
membered that the correction or removal of a single pelvic
abnormality does not often effect a cure; (4) meddlesome
pelvic interference by both physicians and surgeons in the
treatment of these cases is to be condemned, for the patient
first requires systemic treatment and management; (5) cer-
tain ovarian diseases, as mentioned, and most ovarian neuro-
ses do not usually require operative measures, better results
being obtained by proper and continuous lines of medical
treatment; (6) surgical measures, if decided upon, are often
undertaken without sufficient constitutional preparation of
the patient for the operation ; ( 7 ) frequently these operations
are too radical, and are undertaken before medical measures
have been given a full and fair trial, and are graver than
usually considered, for the resort to surgery robs the patient
of the last hope for health ; and if unsuccessful induces a
train of symptoms more serious than the original condition;
(8) if a surgical operation is decided upon, the nonreference
of the case back to the family physician for final cure is fre-
quently a serious mistake, for otherwise only an anatomical
cure is effected, and not a physical and psychic one; (9) to
obtain the best and most permanent results it is necessary

]Sr. C. MEDICAL, SOCIETY. 369

that the family physician, who first sees these cases, should
use all available means for their cure and for the prevention
of threatening complications, and that if these do arise and
surgical methods are indicated, there should be harmonious co-
operation between the referring and attending consultants
both in the proposed treatment and subsequent management
of them.

370 FIFTY-FIFTH ANNUAL SESSION

THE GENERAL PEACTITIONER AS A SURGEON.

BY EDMUND HARRISON, M.D., GREENSBORO, N. C.

Mr. President J Ladies and Gentlemen: — i\.bout twenty-
four hundred years ago a great physician subscribed to a
great oath, and in this oath we find the following: "I will
not cut those suffering with stone in the bladder, but will leave
that for special operators." *

It is very evident from the preceding that, while Hippoc-
rates stuck to the straight and narrow way of the general
j)ractitioner, there were other physicians at that time who
did branch out into special lines, and by so doing incurred
the displeasure of the father of medicine ; but at the present
time a physican can be in good standing without endorsing
this clause in the oath of Hippocrates, which fact seems to
make it appear that the general man is slowly becoming in-
dependent, and perhaps, in the course of twenty-four hun-
dred years more, may be permitted to do even an appendec-
tomy without having to apologize for his presumption; yet,
within the short period of years measured by my profes-
sional life (and I am a very young doctor), the surgeon has
been raised from the level of the physician and placed upon a
pinnacle so high above him that sometimes the surgeon him-
self has difficulty in recognizing this good man in the dim
distance below.

There are now, and always will be, three classes of gen-
eral practitioners :

The first and largest class embraces those who do their
own simple surgical work.

The next largest (and much too large) is composed of those
who do anything and everything from dispensing their own
teething powders to performing a pan-hysterectomy.

The third and smallest class claims those who shiver at
the sight of a scalpel, but bow down and worship the scalper.

N. C. MEDICAL SOCIETY. 371

The last two classes are too much for my comprehension,
so my remarks Avill refer chiefly to class number one.

If we glance at the papers of the ISTorth Carolina towns
we find that the professional cards of the general practitioners
read:

"Dr , Physician and Surgeon" (with append-
ages). If the card is legitimate I see no objection to the "and
surgeon," for I don't believe that the time can or ever should
come when the family physician will feel it his duty to refuse
to treat the simple surgical cases that he meets with in his
daily rounds.

Surgery is decidedly more attractive than medicine. It
is much more exact (and less exacting) ; it allows us to exer-
cise our organs of special sense to a greater extent; its results
are quicker and more apparent; therefore, more flattering;
it inspires the laity with more awe ; and, finally, it pays fees
which, when compared with medical fees, would alone indi-
cate two different professions.

For these reasons the overworked, unnoticed and under-
paid doctor in general practice too often attempts more
surgery than either his skill or experience warrants, the pa-
tient getting the rest — requiescat in pace — the preacher the
prominence, and the undertaker the big fee. Then, too,
the medical colleges have allowed surgery to claim too much
of the student's time ; so much so that the recent graduate,
who can not make a diagnosis in the simplest medical cases,
does not hesitate to attempt the most dangerous surgical ope-
rations.

As surgery is much more of an art than a science, and
medicine much more of a science than an art, the surgeon
should serve a much longer apprenticeship for he must learn
from watching and helping others.

In view of all these things how much surgery, then, should
the general practitioner do ? For obvious reasons the surgeon
should not decide this question ; if we care to maintain peace
in the family our brother physician must not attempt it;

372 FIFTY-FIFTH ANNUAL SESSION

we can not seek the aid of the law, for it has failed to control
even the qii'jcks and humbugs; then, all that is left is the
individual conscience, undistorted by ambition or smothered
by self-interest; a conscience that weighs even the insignifi-
cant danger of an anesthetic; a conscience that is not satisfii.d
with merely the life of the patient, but looks into the future
years of that life ; a conscience that realizes that an ovary is
more than a small particle of offending tissue, or that weak-
ened abdominal walls may transform an industrious mechanic
into a whimpering invalid. Such a conscience, whether
"Medical" or "Surgical," must answer this question.

Every general practitioner should keep fresh in his mind
the principles of surgery, and he should be as surgically clean
as is the abdominal surgeon, for he never knows when an
emergency will forbid his passing the responsibility to the
specialist, and force upon him the opportunity to save a
human life.

It is extremely seldom that the difficult and dangerous
surgical operations can not wait for the surgeon to be called,
and it is equally seldom that emergency surgery is of such
technical nature that the good general practitioner can not
meet the requirements of the case with less danger to the
patient than would be involved by waiting for the surgeon;
therefore, I consider emergency surgery a part of general
practice, and in the country districts and towns too small to
support the "Simon-pure" surgeon circumstances so demand.

The family physician is the adviser of his clientele, and
his opinion is held above that of the surgeon, even when the
case is a surgical one ; therefore he should know thoroughly
the theory of surgery; but he must be a conservative man,
able to protect his patient from the radical ideas of the ex-
tremist; and yet what could be more radical than for this
family doctor, who operates possibly once in two months, to
perform an abdominal section in order to save himself the
embarrassment of having to confess that there is another who
can do it better.

N. C. MEDICAL SOCIETY. 6i6

Let the interests of the patient be the guide, and the doctor
will certainly know his limitations in surgery ; but let his own
ambitious interests lead him and soon he will believe that
his ability has no limit.

Circumstances and surroundings compel some physicians
to do more surgery than others ; and again, some physicians,
by reason of their natural gifts or better training, are much
more capable than others; but, presuming that a surgeon is
available, and that the general practitioner knows the princi-
ples of surgery and of honor, then my rule would be:

Let the general practitioner do the surgery that he knows
he can do well, but when there is a vestige of doubt in his
mind as to his ability, then, in justice to his patient, his pro-
fession and to, himself, he should seek the aid of the special-
ist; nor should procrastination render this aid futile, and
bring upon both physician and surgeon the discredit that so
often follows the unsuccessful surgical operation.

374 FIFTY-FIFTH ANNUAL SESSION

THE EELATION OF THE SURGEON TO THE GEN-
ERAL PRACTITIONER.

BY T. E. W. BROWN, M D., ASHEVILLE, N. C.

Mr. President and Members of the Society: — On looking
at the title of this paper as given in the program I have no
doubt but that many of you are wondering which phase of
the many and complex relations which exist between physician
and surgeon will be considered. I will deal with that rela-
tion which must exist to bring about a perfect or nearly per-
fect cure in a patient that has undergone an operation. This
relation, like many others that exist between them, is hard
to define, and I shall not presume to lay down rules nor to
make any final disposition of it. I shall simply direct your
attention to it.

Let me first call your attention to the word "cure." What
do we mean by it ? What does the patient consider a cure ?

I can best explain by quoting freely from a recent article
by Dr. James G. Mumford, Boston. He says :

"I take it that a cure is the important end of all therapeutic
endeavor : a perfect cure is the summum bonum onum, but
is it not true that a large proportion of our cures are relative
only ?

"The man with a disabling recurrent appendicitis is ab-
solutely cured of all pain and digestive distress through the
removal of the appendix. The man with gangrene of the
foot is relatively cured by amputation, though he be left
maimed and halt. The woman with an ovarian cyst enjoys
an anatomical cure when the tumor has been excised and the
wound has healed kindly and soundly, though an unessential
organ has been removed. All these are clinical cures, are
cures from the surgeon's point of view ; but just here there
enters into the problem an element of wide-reaching meta-
physical significance. The ills of life, like all the so-called

N. C. MEDICAL SOCIETY. 375

facts of life, are in direct relation and are proportionate to
our experiences. The man who has just lost his appendix,
if he lacks poise and clear vision, feels that he has been
through a grievous crisis ; that he has suffered a great cruelty
in the operation ; that the sanctity of his vitals has been vio-
lated, and that he can never again be what he was. The wo-
man who has lost an ovary believes herself to have been un-
sexed; she has heard tales of changes of temperament; of
coarsening features; of mannish tendencies, or perhaps she
thinks a full set of ovaries essential to sound health and the
bearing of womanly cares. She looks forward to some mis-
terious ill-defined change in herself, or to invalidism, and
the reassuring farewell words of the surgeon fail to turn her
from the expected melancholy course."

Such cases as Dr. Mumford has cited are common to all
of us. A satisfactory operation does not always mean a satis-
fied patient. This dissatisfaction on the part of the patient
may be produced in many ways ; it may be due to ignorance,
brought about by the failure of surgeon and physician to
sufiiciently explain beforehand just what is to be obtained
by the operation; it may be due to a chance word dropped
by a nurse in the presence of a patient as once happened to
me. A new nurse assisted me at an appendectomy, and later
" told the patient that she had never seen the operation per-
formed just as I did. This aroused a great doubt in the mind
of my patient as to her ultimate cure, and was not relieved
by anything I could say or do, and not until some time after
she left her bed, and then only after a painstaking effort on
the part of her physician did she consent to believe all was
well with her.

Patients are not to be considered as machines which act
always in the same way.

Given a patient with a surgical condition it does not follow
that a cure in its true sense will, result when operation is
furnished.

Diseases per se are the same, but act differently according

376 FIFTY-FIFTH ANNUAL SESSION

to their surroundings ; that is, according to the patient.
Therefore, in order to obtain a cure, not only must the disease
be handled according to the rules for that special disease but
also according to its locality, which is the patient.

A beautiful painting does not arouse the same ideas in
all who gaze upon it, neither does a disease produce the same
mental impression in all those suffering with it ; and it is
easy to see that a surgical procedure will produce varying
impressions in different patients, though the conditions be
the same and the procedures for its cure identical.

These patients may be likened to a rifle with unadjusted
sights which regularly shoots too much to the left or to the
right, too high or too low ; the cartridges are the same, the
target is the same, the man who uses it is the same, but he
will miss the bull's-eye if he does not allow for the "personal
error" of the rifle.

Since the majority of surgical cases are first seen by a
physician, who later calls in a surgeon to aid in relieving the
patient of the specific morbid condition, it is equally true
that it is the combined duty of physician and surgeon to re-
lieve the patient of aberrant mental conditions produced by
the disease or the operation.

To lay down specific rules for combating these conditions
would be worse than foolish. The cure is not brought about
by what the physician says or does alone, nor by what the
surgeon says or does alone, but a cure is the result of what
they both say and do together. It is the result of their com-
bined efforts on both the body and mind of the patient. This
is best obtained by working and talking together. It is a
work of explanation to the end that the patient be educated
to a proper knowledge of his condition.

]S'. C. MEDICAL, SOCLETY. 377

SOME OBSERVATIO^TS 0^^ PELLAGRA IIT THIS
COUNTRY WITH SPECIAL REFEREITCE TO PEL-
LAGROUS INSANITY.

BY JOHN McCAMPBELL, M.D., MORGANTON, N. C.

Pellagrous insanity, as the name implies, is so closely as-
sociated with and dependent upon a general systemic disease
that its consideration separate and apart would be difficult
and hardly profitable, it being in reality only one of the late
manifestations of the malady known as pellagra, which has
been comprehensively defined by Van Harlingen as "a com-
plex disease characterized by three classes of symptoms :

"1. A squamous erythema confined to those portions of the
skin which are exjDOsed to the action of heat and light.

"2. A chronic inflammatory condition of the digestive
passages shown chiefly by obstinate diarrhoea.

''3. A more or less severe lesion of the nervous system
leading at times to mental alienation and paralysis.

''These various symptoms are at first insignificant and in
a certain way periodic. They begin or recur in spring and
diminish or disappear in winter. Later they become per-
sistent, more and more marked, and finally terminate fa-
tally."

Pellagra has been kno\vn to exist in Italy, Spain and ad-
jacent countries for more than a century and a half, and was
scientifically investigated in Italy as far back as the year
1771, but until quite recently there has been very little said
in this country on the subject. In fact, the existence of the
disease has been denied by some of the most eminent medical
writers of recent years, the subject being dismissed with brief
mention and the statement that it is a disease confined to
certain European countries. It is true that cases simulating
pellagra were reported in the early sixties by Dr. Gray, of
New York, and Dr. DeWolfe, of Nova Scotia, but the genu-
ineness of these was questioned at the time and the disease

378 FIFTY-riFTH ANNUAL SESSION

either disappeared or was overlooked (the former laost likely)
until attention was again called to it by the publication
within the past year of the observations of Drs. Searcy, of
Alabama ; Babcock, of South Carolina ; Wood, of this State,
and possibly others, though some doubt apparently exists in
the minds of some of these observers, as is evidenced by the
fact that Dr. Babcock presents his able, and to my mind
convincing paper, in the form of a query.

My own experience leads me to believe that we now have
in this country, probably of recent development, a grave and
usually fatal disease identical with the pellagra of Southern
Europe, and which may, under favorable conditions, gain
the proportions of an epidemic. During the past four years
I have, from time to time, encountered mental cases present-
ing certain definite and rather uniform manifestations and
associated with a peculiar skin eruption, which I was unable
to fit into any recognized classification; yet I realized that
I was dealing with a distinct entity, and it was not until the
earlier of the last referred papers came into my hands that I
was convinced that the disease in question was pellagra and
the mental disturbance present constituted pellagrous insanity
pure and simple. In support of this belief I wish to re-
count the chief etiologic and symptomatic features as ob-
served in twelve of these cases, with special reference to their
mental aspect, since all of them were so far advancd in the
disease as to necessitate their commitment to a hospital for
the insane.

The theory generally, if not universally, accepted is that
pellagra is in some way associated with the ingestion of In-
dian corn which is diseased, harvested immature, or in some
way damaged and consequently containing a toxic substance,
the exact nature of which has never as yet been very clearly
defined. Ballardini considers it a parasitic growth on mouldy
or musty maize, while Lombroso suggests that it is due to
the occurrence of a fatty oil and an extractive substance, the
product of decomposition or bacterial action which are never

]Sr. C. MEDICAL SOCIETY. 379

present iu sound corn. At any rate, the disease is more in
the nature of a ptomaine poisoning than a direct bacterial
infection. This would naturally be supposed since most of
the corn and corn preparations which are used as food have
been cooked, and thereby subjected to a sterilizing temper-
ature. It is of interest to note in this connection that I have
recently had an opportunity to interview several native Ital-
ians of the peasant class, who had some knowledge of the dis-
ease, and they invariably assigned as the cause the eating of
polenta three times a day; and they attached considerable
importance to the fact that it was eaten three times a day.
Polenta is nothing more than ordinary com mush. I am
unable to determine the exact character of diet previously
used by any of my cases, but there is good reason to suppose
that corn was extensively eaten, and it will be conceded that
this prime etiologic factor was present.

Locality within the State seems to have no particular in-
fluence, as the twelve cases were distributed impartially over
the territory extending from Robeson to Madison counties.
All of these cases were women, which fact is at variance with
the common teaching, since the two sexes are supposed to
be equally susceptible. The negative bearing of this circum-
stance is eliminated by the fact that at the time these obser-
vations were made my service was confined to wards for wo-
men. In the epidemic occurring at Mt. Vernon, Alabama,
and reported by Dr. Searcy, eighty out of eighty-eight af-
fected were women. The average age was thirty-eight years.
Nine out of the twelve cases ranged from thirty-eight to
forty-five, which is of no special significance unless it be
that the nervous instability consequent upon the approach
of the climacteric in some way predisposes to the disease.
Eight or two-thirds of the twelve cases showed first mental
symptoms in either April, May or June, and two others in
July and August. Allowing for a slight delay in the occur-
rence of mental disturbance in these two cases, we have ten
out of twelve occurring in conformity to the usual seasonal
incidence of the disease, it being understood that most cases

380 FIFTY-FIFTH ANNUAL, SESSION

develop or recur in the spring and early summer months.
There was a total absence of heredity in all but two cases,
and in these it was remote — an insane uncle in one and an
insane niece in another, l^either was there an instance of
parental consanguinity.

Absence of these factors, which are important in the causa-
tion of most insanities, point to the exogenous character of
the disease and renders it less likely that the ordinary in-
sanities have been confounded with this series of cases. All,
Avith two exceptions, were exceedingly poor and most of them
bore evidences of having undergone extreme privation. These
conditions, no doubt, contributed to the development of the
disease both by the malnutrition consequent upon an insuffi-
cient diet, and also by the fact that poverty of that degree
usually necessitates the use of corn to a greater extent than
is customary with people in better circumstances.

All the cases under consideration having, before coming
under observation, reached a condition of extreme mental
alienation, it naturally follows that we are dealing with the
latter stages of the disease, and data concerning the earlier
symptoms are lacking. It appears from the histories givsn
in the commitment papers that in a vast majority the mental
symptoms were preceded by or associated with ill health, this
period of ill health being in all probability nothing more
than the lassitude, general debility and digestive disturbance
common to the earlier stages of the disease. In fact, a run-
down condition, debility, indigestion, general catarrhal con-
dition of the intestinal tract and like troubles are specified
in several of the cases.

The beginning of the psychic disturbance was usually
marked by a period of anxiety and worry, undue importance
was attached to trivial affairs and misfortunes were appre-
hended. Occasionally unusual religious interest was mani-
fested. This was followed by disturbance of perception and
the development of hallucinations, usually auditory, though
occasionally visual as well. Judgment was profoundly dis-

N. C. MEDICAL, SOCIETY. 381

turbed, giving rise to delusions, which were characteristic in
that they were, with only one exception, depressive and pain-
ful in nature, though they lacked the self-accusatory quality
of the usual delusions of simple melancholia, being rather of
fear and suspicion, or more specifically, one thought that she
was to be burnt up ; another, that she was burning in torment
and her child recently dead was also in hell. Still others
thought that poison was put into their food or that they were
to be hurt or injured in some way.

At this stage threats and attempts at suicide were rather
frequent and occasionally homicidal tendencies were present.
Two cases showed very decided emotional instability. As the
disease progressed memory became grossly defective and ori-
entation as to time, place and persons was imperfect. Inco-
herence of speech Avas common and was usually of the most
desultory variety. Neither distractibility nor true flight of
ideas were observed at any time. There were instances of
muteism, the patient appearing dazed and failing to respond
to questions and orders of the simplest kind, due probably
to clouding of consciousness and a failure to comprehend.

Motor restlessness and insomnia were prominent with a
disposition, even when extreme weakness was present, to get
out of bed, tangling and scattering the bed-clothes about the
room in a most aimless manner, and a kind of senseless resist-
ance was made to efforts at exam.ination. A total disregard
for cleanliness soon appeared and all became extremely un-
tidy in habits ; this from mental habitude and indifference
rather than viciousness. There was an early failure of ap-
petite and frequently absolute refusal of food (often due to
delusion), necessitating forced feeding with nasal tube.

These mental symptoms without remission steadily grew
more and more pronounced until a condition of complete
armentia ensued, and, coupled with the physical weakness
present, was not unlike the so-called typhoid condition, and
especially so, when the delirium assumed a muttering char-
acter. Coexistant with the mental condition described there

382 FIFTY-FIFTH ANNUAL SESSION

was invariably present an eczematoiis involvement of the
skin, varying all the way from a thickened, roughened and
pigmented condition, with a tendency to j&ssure, to a typical
exfoliative dermatitis. These skin changes were distinctive
in that they were limited to exposed areas, the backs of the
hands escaping in no instance, and in this location the milder
cases strongly suggested sunburn. The involved surfaces
were uniform and ended abruptly, usually at or just above
the wrists. The line of demarcation was very distinct and
corresponded closely to the limit of protection afforded by
the sleeve or arm covering. The eruption occasionally ap-
peared on the face, especially at the angles of the mouth, and
once upon the forehead, but was not observed on the feet.

There was a tendency toward pigmentation and scaliness
over the bony prominences, even where protected by the cloth-
ing, and especially so where counter pressure was exerted.
This was most marked at the point of elbows and front of
knees, though in these places it was never as severe as where
exposed to the action of the sun's rays.

The nervous disturbance consisted in exaggeration of the
deep reflexes, coarse intention tremors, ataxic and choreic
movements of the extremities, especially the arms ; and later
this incoordination frequently involved speech, rendering it
halting, slurring and finally inarticulate.

The pupillary disturbances were slight, variable and incon-
sistent. As the end approached there was a general spastic
condition of the muscles with marked retraction of the neck
and head, and a mere tap at almost any point on the body
would excite a slight tetanic convulsive movement. Diar-
rhoea was usually present, characterized by obstinacy and an
exceedingly offensive and putrescent odor of the ejecta.

All twelve cases terminated fatally. The course of the
disease was rather rapid. The average duration after the
beginning of mental symptoms was three and one-half months.
The average duration after admission to the hospital was
fortv-four davs.

N. C. MEDICAL SOCIETY. 383

The foregoing mental sjmptom-coniplex, altkongli some-
what contradictory, or at least inharmonious, might be to
some extent associated with any of the toxic or exhaustion
psychoses, since many of the symptoms mentioned are com-
mon to most of these conditions, without regard to the par-
ticular morbific influence in operation, and it was only by the
somatic disturbance invariably present, chief among which
were the skin lesions, that differentiation was possible.

I am aware that the number of cases studied is rather
small and the records from which the histories are taken too
incomplete to altogether justify a dogmatic statement, yet I
believe that sufficient has been said to show the close similarity
of these cases to the descriptions of pellagra given in the
classic writings on the subject.

And I would say, further, that this paj)er is not presented
with a view to adding anything to the literature of the sub-
ject, but rather in the hope that I may, in some measure, at
least, aid in directing the attention of the profession gener-
ally to a danger which possibly threatens us, since an early
recognition is all-important, for it is only by prophylactic
measures that we can hope to accomplish anything.

To show that this danger is not altogether imaginary, I
will say that out of twenty deaths occurring among women
in the State Hospital at Morganton during the past year, five,
or twenty-five per cent, granting the correctness of diagnosis,
were attributable to this disease, a number in excess of those
assignable to any other one cause, tuberculosis included.

384r FIFTY-FIFTH ANNUAL SESSION

PELLAXIEA.

BY E. J. WOOD, M.D., WILMINGTON, N. C.

Pellagra is a disease sujjposed to be due to an iutoxication
derived from diseased maize and characterized by the triad
of symptoms : symmetrical erythema, gastro-intestinal dis-
turbances and varied nervous and mental manifestations.

Spain was the first country in which pellagra was recog-
nized. This was in 1735, and the disease was regarded as a
variety of lepros3\ The disease later appeared in Galatia,
and later in Castilia, Rome and Aragon. To-day it is very
prevalent in Navarre and Galicia. The name lep~a asturi-
ensis was one of the many by which it was known. Next the
disease was noted in the northern provinces of Italy. Tra-
palli, in Lombardy, gave the name pellagra (pelle and agra,
rough skin).

At the present time pellagra is very prevalent in Rou-
mania. In 1882 there were 4,500 cases ; in 1888 there were
10,626 cases out of a population of 5,339,650 ; in 1894, 6,694
cases; in 1898, 19,796 cases; and a more recent estimate
places the number above 50,000 cases, who were affected
with the disease in some stage. It also occurs in the south
of France. Since 1856 it has been present in Corfu. The
Asturias are still the chief seat of tlie disease in Spain. One
sporadic case is said to have occurred in England.

When the disease first appeared in Italy it was in the
neighborhood of the Lago Maggiori, During the last century
it extended into Emilia and Tuscany. In Central Italy it is
little known, and in Southern Italy and Sicily is unknown.

Bouchard described the disease in Mexico. It has occurred
also in Brazil, Argentine Republic and Uruguay. Many
cases have been reported from Egypt and some from South
Africa.

The disease has almost disappeared from France, but there
are still small areas in the Pvreness and in Garonne.

N. C. MEDICAL SOCIETY. 385

Sporadically cases have been seen in the Tyrol, Servia, Bul-
garia, Greece and Asia Minor.

Italy and Eoumania are considered the disease centers. In
Italy it is endemic. According to a reliable source there were
100,000 cases or ten per cent of the rural population affected
with pellagra.

The disease Avas supposed not to occur in this country, and
many of the best text-books fail to mention it. Probably the
first article on the subject appeared in the Journal of the
American Medical Association for July 6, 1907, by Dr. G.
H. Searcy. The disease appeared, according to this report
in 1901, in Tuscaloosa, Alabama, but at the time was not
recogrdzed. In 1906 there occurred in Mount Vernon, Ala-
bama, 88 cases of acute pellagra with a mortality of 57 or
64 per cent.

In 1905 the disease was present, unrecognized, in Wilming-
ton. Certainly as far back as 1900 there was a case in Jones
County.

Dr. James McKee, Superintendent of the State Hospital
for the Insane at Raleigh, has kindly furnished me with
notes of three cases under his care and suggests the possibility
of the disease having been present in the institution for a
number of years.

Dr. R. H. Bellamy, of Wilmington, at the recent meeting
of the American Medical Association reported ten cases.

Dr. J. C. Gilbert, of Hope Mills, in a letter to Dr. Bellamy
reports seven cases under his care.

Certainly there have been thirty cases in ISTorth Carolina.
It is probable, however, that the correct number will run into
the hundreds. It is also probable that the disease is rapidly
increasing. We have many reasons to believe that the dis-
ease has existed in North Carolina for some years, but that
these cases were sporadic, otherwise the condition would long
ago have been recog-nized. That there has been an increase
from a few sporadic cases to a number which is daily in-

386 FIFTY-FIFTH ANNUAL SESSION

creasing, the question of the disease becoming endemic with
us, must be seriously considered.

Pellagra seems to be generally distributed throughout the
South. Merrill reports a case from Colorado, Texas, and
Babcock report nine cases occurring in the Hospital for the
Insane in Columbia, S. C.

Symptomatology.

Weeks and even months before the appearance of the
erythema of pellagra there may be symptoms which, while
usually very indefinite, would lead one in a pellagrous region
to make the diagnosis provisionally of the disease. There is
often progressive weakness, especially of the feet and legs,
gastric disturbances and loss of appetite. Roussel regards
the loss of appetite and gastric disturbance as complications,
and dryness and burning of the mouth with a sensation of
heat in the stomach which may develop into a true pyrrhosis
as the first symptoms of the disease. Further, he considers
voracious appetite, vomiting, cardialgia and diarrhoea of
purely nervous origin. Besides these symptoms there are
vagabond pains in the extremities and back, tinnitus, weak-
ness of vision, general malaise, especially in the mornings.
Sometimes pain in the joints. Headache, vertigo and melan-
cholia follow.

In many respects these symptoms are common to the whole
group of acute infectious diseases, but still, when headache,
vertigo, sensations of weakness especially of the lower ex-
tremities are present, often accompanied by diarrhoea and
occurring about the middle or end of winter, our suspicion
at least should be aroused.

According to Theodori about four weeks after these pre-
pellagrous s}Tmptoms occur the unmistakable signs of the
disease appear. This period is often much longer, in some
instances being as much as a year.

The first skin lesion almost always appears in the spring,
and the parts affected are usually those parts exposed to the

JS". C. MEDICAL SOCIETY. 387

sun's rays. Many of the best observers think that as an eti-
ological factor the rays of the sun have little effect. Among
these are no less authorities than Procopin and Tuczek, to
whose work we are much indebted for our information. Many
other writers think that the violet rays are certainly a pre-
disposing cause of the skin lesion if nothing more. The last
word on the subject has not been said. In our cases we are
disposed to belittle the solar influence : ( 1 ) Because the dis-
ease appears with us so early that we can exclude any very
intense action; (2) in some cases it appears over the sternum,
in the vagina and in patients who have been in bed for days
and weeks with a pellagrous lesion on the hands and face we
see the extension to the feet, even though previous to their
admission to the hospital they had not gone barefooted.

The skin lesion usually appears first on the back of the
hands over the metacarpal region, either with a swelling and
a red spot in the centre or else with a diffuse redness. Often-
times blebs appear. These blebs contain clear, alkaline serum
which is sterile. After the hands the face is usually more
apt to be affected. Here the lesion begins symmetrically
either at the outer canthi of the eyes or at the angles of the
mouth. It is common to have it symmetrically situated on
the forehead in two patches, which have a narrow vertical
strip of healthy skin between. Beneath the lower lids and
at the back of the neck are favorite places. In the latter
situation the lesions extend anteriorly until they nearly meet
in front, forming a collar which is higher behind. In our
limited number of cases we have found the face and neck
lesions much more commonly in females and especially chil-
dren. The next spot selected is the tops of the feet. Our last
case has the two varieties of lesions occurring simultaneously.
Just below the external malcolus there is a bleb on both feet
which began as two round, red spots about the size of a fifty-
cent piece. In ten days a bleb appeared which, after drying
up, left a raw surface. In the same case over the crest of the
tibia extending downward over the metatarsal region to the

388 FIFTY-FIFTH ANNUAL, SESSION

lower articulation of the toes is a dift'use redness much re-
sembling a lymphangitis.

This lesion will probably go on to exfoliation without bleb
formation. In some cases the lesion may appear over the
sternum, and in two of our cases the labia pudendi were af-
fected by the typical lesion. The disease has been known
to make its first appearance on some covered portion of the
body, but this is exceptional. In none of our cases did it
appear there until long after its more usual appearance on the
exposed parts. In the lesions with blebs there is left a raw
surface which either forms an ulcer or is covered by crusts
which often are quite thick. The crusts and the weeping
ulcerated areas, together with the odor, make a loathsome
patient. With the beginning of healing the skin of the face
contracts so that in one case there was a marked ectrapion
and also inability of the lips to cover the teeth. The photo-
graph shows the condition well, but it became much worse as
the disease progressed. Usually, especially in the dry cases,
exfoliation begins after three or four weeks, and as the dead
skin comes away a pigmented area is left. This pigment
varies from a slight yellowish tinge to a dirty brown or even
a chocolate color. The depth of color depends upon the dura-
tion of the disease, that is, on the number of the attacks. In
addition to the pigmentation the skin is shining and atrophic.
By fall the skin regains more or less of its normal tone, only
to be ready for a next attack in the following spring. With
each attack the skin becomes more atrophic and more pig-
mented.

Intestinal Tract.

With the appearance of the erythema, or soon after, the
mouth becomes affected. The mucous membrane is red and
swollen, the lips may be covered with blisters, and later they
become cracked and seared. The tongue is intensely red and
the papillae enlarged with furrows between. The patient
complains often of burning and salty taste in the mouth often
with an increased flow of saliva.

N. C. MEDICAL SOCIETY. 389

Dr. McKee says that the mouth suggests to him stomatitis
materna. Salivation is often intense, and in one of our cases
we suspected ptyalism. After the skin lesion the mouth con-
dition is the most constant, and in none of our cases was it
absent. In some cases it subsides after the first few weeks,
in others it persisted throughout.

In all of our cases the stomach was not affected. Pyrrhosis,
eructations, vomiting, anorexia or bulimia, often with ex-
treme thirst, are common symptoms. In some cases the gas-
tric analysis shows an absence of hydro-chloric acid, while in
others it is normal.

Much more commonly present is obstinate bloody diarrhoea,
often of a dysenteric type usually attended with colic. This
diarrhoea is considered by many to be a neurosis, but it is
often difficult to believe judging from the character of the
stools.

j^EKvous System.

Roussel considered the vertigo a very characteristic symp-
tom and described it as being much like a gastric vertigo.
Diplopia and amblyopia are common, but were absent in all
our cases. The pupils react acutely to both light and ac-
commodation, and the opthalmoscopic examination has re-
vealed nothing to us. The patients usually complain of a
sensation of heat or cold in various parts of the body. We
have attempted to investigate the tacticle sense, the sense of
heat, cold and pain, but our observations are inaccurate be-
cause of the mental state of our patients. The complaint of
pain, especially in the shoulders and epigastrium, is quite
common and noted by us.

Convulsions are quite common and often close the scene.
In one of our earlier cases this was so. Tetany is reported
by some. We have found a coarse tremor present in a num-
ber of our cases. In one just before death her whole body
was in a constant tremor, but could not be accounted tetany.

The condition of the tendon reflexes is most variable. In
many of our cases they remained normal. In a few they

390 FIFTY-FIFTH ANNUAL SESSION

"were absent, though there were no ether symptoms of loco-
motor ataxia. In one case where the reflex had been absent
there was a return before death in a rather exaggerated form.
In one case it was much exaggerated and ankle clonus was
present. In one case it was present on one side and absent
on the other. Usually in the beginning of the disease it is
normal or decreased, but later, when the lesion in the cord
has extended, it is apt to be exaggerated. Station is usually
good. The gait becomes unsteady but not atoxic. A slight
spasticity has been observed. Among the baso-motor and
troptic disturbances is usually included the erythema itself.
In addition we often find paleness of the skin, sensations of
cold, "goose flesh" and muscle atrophy in the shoulder girdle
muscles of the hand, throax and lower leg. This should not
be confounded with emaciation, which is often extreme. The
alterations in the tongue and the thickening of the nails may
be included under this head.

In Europe "misery and poverty" are counted the chief
predisposing causes of pellagra. Just those conditions oc-
curring among the peasantry in Europe are almost unknown
with us. Certainly the richest and the poorest buy the same
grade of com meal. The chief difference here, as we all
know, is in the fact that the poorer classes have less variety
and often the food is poorly prepared. We are disposed to
think that pellagra with us is not so much a respecter of per-
sons, affecting the well-conditioned as well as the victims of
previous disease, and poor hygienic sun-oundings.

It has been shown, especially in Sandeith's Egyptian cases
that the parasitic diseases seem to form a very definite pre-
disposing cause. Especially has it been noted that anchylos-
toma is often present. One such case was noted by Harris in
Georgia. Babes and Sion report the occurrence of malaria in
eight of their twelve cases. We have had occasion to consider
seriously this possible relationship. My first case, which was
erroneously reported in the Jouiyial of the American Medical
Association, had a latent malaria and the unusual condition

I^. C. MEDICAL SOCIETY. 391

of a mixed infection with tertian and qnartan organisms.
Much attention has been paid to the occurrence of alcohol
and syphilis with pellagra. This is unimportant except in
so far as these conditions lower the resistance.

The course of pellagTa is very variable. In Italy it is no
uncommon thing for the outbreak to occur each succeeding
spring for twenty years. Each year the patient becomes
more wrinkled, more atrophic and more melancholy until,
finally, they die from some intercurrent disease, as broncho-
pneumonia or of cachexia.

There recently came under our care a typical case of
chronic pellagra which is worthy of note.

Mrs. W. ; age 34 years ; Jones County. Family history
negative. Previous medical history negative save for ma-
laria and typhoid. T^o history of miscarriages. In spriug
of 1906 she was affected with gastro-intestinal symptoms,
one month after the appearance of which the erythema ap-
peared on her hand and the lower third of her forearms. In
the spring of 1907 the same condition recurred. In May,
1908, the condition made its third appearance, was diagnosed
pellagra and reported to me by my colleague. Dr. Thomas
M. Green. Her condition was as follows:

A poorly nourished woman, much older in appearance than
the age given. Symmetrically situated on her forehead
were two patches of desquamating erythema. These patches
are about equal to the size of two silver dollars. The same
lesion surrounded both eyes. On the upper lid the lesion was
more recent, with the presence of crusts and a weeping surface
beneath. This lesion extended into the anterior nares. On
the skin below the eyes the lesion was older and there is a
slight brownish pigmentation. On the backs of both hands
from the finger nails to the middle of the forearms poste-
riorly is this same condition of the moist variety. The le-
sions were especially aggravated over the knuckles and tips
of the ulna. The same condition was present on the anterior
surface save for the palms, where there was simple redness

392 FIFTY-FIFTH ANNUAL SESSION

without exfoliation. ISTear the upper margins of the arm
lesions was found considerable brownish j^igmentation. On
the back of the neck was a much older lesion, which had
caused a tawny pigmentation. Posteriorly this lesion is
about two inches in length, but as it extends anteriorly it
becomes narrowed, almost meeting in front. The labia pu-
dendi were affected with the moist lesion.

Heart and lungs were negative.

Spleen and liver negative to palpation and percussion.

Urine showed albumen and granular casts.

Blood showed a simple anaemia of moderate degree.

jSTo leucocytosis. Differential leucocyte counted showed
no abnormal variations. Blood cultures were taken.

The patient's mental condition became rapidly worse, she
refused nourishment, and a restraining sheet had to be used.
In her mania she would rub off the crusts from the arm
lesions especially, and the picture that resulted was horrid,
with the raw, bleeding surface and the bed clothing covered
with blood and pus.

She died of exhaustion.

Our knowledge of chronic pellagra is limited, fully 75 to
80 per cent of our cases being acute. It seems remarkable
that Lombroso should have had occasion to differentiate this
acute or "typhoid" pellagra from typhoid fever. There is
certainly no resemblance except possibly in some of the late
nervous symptoms of both diseases.

Our acute cases ran a course from a few weeks to a few
months.

As an example of this is the following :

V. S. (colored); 12 years; Wilm.ington. Referred by
Dr. W. J. H. Bellamy.

Family and previous medical histories negative as far as
we could secure them, except that at this time she has a sister
aged 6 years recovering from the first attack of pellagra.
This child is in my care, and is strong and robust.

In February she had various vague digestive symptoms

N. C. MEDICAL SOCIETY. 393

before she noticed at the outer canthi of the eyes a small red
sjjot. This erythema increased in size rapidly, extending
over the forehead. It next appeared beneath the angles of
the jaw and extended around the neck, meeting behind. The
gums were swollen and red and the whole mucous membrane
of mouth inflamed. The eruption next appeared on the
backs of the fingers and extended upward to the middle of
the forearms. The face and both arms were covered, giving
the appearance of a superficial burn. The contraction of
the skin of the face has been described. From the beginning
the bowels have been affected in the form of a persistent
diarrhoea. The only gastric symptoms have been anorexia
and nausea. With the aid of two doses of santonin during
the past week she has expelled from the bowels forty-six
round worms and vomited one. When first seen a week ago
the feet and ankles were oedematous, but this has disappeared
and the erythema has taken its place.

Knee jerks were absent, but have reappeared. Skin sen-
sations normal. Pupillary reaction normal. She complains
of cold sensations, weakness and pain in right shoulder. She
is now beginning to be quite delirious at times and falls out
of the bed repeatedly.

June 13. The appearance of the face is distressing. The
skin lesion seems really to have extended to the eyes. The
cornea is dry and there is a marked conjunctivitis. Muco-
purulent material flows from each eye. Both lids are so
contracted that the eyes have not been covered for over a
week ; this condition is certainly largely the cause of the ter-
rible state of the eyes.

Belmondo and a number of other observers state that
typhoid pellagra never occurs primarily, that it is always the
exaggeration of a recurrence in chronic cases. We have seen
five cases die in the first attack. The disease must be more
malignant than in Southern Europe. It is difficult to ex-
plain why this should be, except that we know when a disease
appears in a new country the death rete at first is always

394 FIFTY-FIFTH ANNUAL, SESSION

higher. We have examples of that in some of the yellow
fever outbreaks, and better still in the outbreak of measles
in some of the Pacific islands, where the mortality was 90
per cent.

The diagnosis of pellagra after it is well established is
quite easy and does not require yearly recurrences to establish
it. In no disease is an early diagnosis more important than
in this, as our only hope of effecting a cure is in removing
the cause early in the disease.

Ergotism was the first thing thought of in our cases, buc
it was excluded because of an absence of the characteristic
numbness, tingling, vascular stasis, and gangrene of the fin-
gers or toes.

I have had to watch for several days simple sunburn sus-
piciously in some cases because there is nothing more like it.
The erythema of pellagra is described as resembling sunburn
almost exactly. Usually, however, the diarrhoea and stoma-
titis precede.

Pellagra sine pellagra calls for our special attention.
Right now we have a number of cases under this suspicion,
but we must agree with the authority who rather questions
the possibility of such a diagnosis. That such cases have
occurred there can be no question, as the best authorities so
state it.

The treatment of pellagra so far is not promising. Prac-
tically all acute cases die aegardless of treatment. In chronic
cases that are not too far advanced the removal of all corn
food with tonic treatment, together wath improved hygiene,
often brings about recovery with or without mental deteriora-
tion, depending upon the stage of the disease when arrested.
Babcock is using successfully atoxyl hypodermically in doses
of one to one and a half grains every four to seven days. In
much larger doses in the acute affliction it has failed in my
hands. Babcock is also using Soamin (Burroughs, Wellcome
& Co.) in one grain doses three times a day. In Wilming-
ton we have exhausted the pharmacopoeia without seeing any
benefit derived bv the sufferers.

JSr. C. MEDICAL, SOCIETY. 395

VACCINE OR TUBERCULIN THERAPY IN THE
TREATMENT OF TUBERCULOSIS.

BY H. B. WEAVER, M.D., ASHEVILLE, N. C.

To the bacteriologist we owe much ; for it was he who stood
alone, single handed fighting an army of doubters, and laid
a foundation upon which the pathologist was forced to build.
From him we received our first knowledge of bacterial life,
and its relations to infectious diseases. It was the immortal
Virchow, assisted by Klebs, w^ho first announced the new
theory that all functions of the body are but manifestations
of activity or dormancy of the cells of the organism.

They first demonstrated to the world in 1877 that the in-
oculations of animals with cultures from tuberculous products
produced similar lesions to those following the direct infection
of tuberculous tissues themselves. This work, persisted in
by Klebs, led eventually to the discovery by Koch of the
tubercle bacillus, the real cause of the disease, the essence of
which constitutes the vaccine in tuberculin therapy.

Hammerschlag is credited with having first made investi-
gations regarding the nature of extractives of the tubercle
bacilli, but to Robert Koch is due the honor of discovery of
the principles and preparation of an emulsion of the powdered
dead bodies of the tubercle bacilli — old tuberculin, which
has stood the test of time in its therapeutic application in the
diagnosis and cure of tuberculosis.

This leads us to inquire into the principles which underlie
the vaccine or tuberculin therapy of tuberculosis.

What is vaccine therapy ?

It is the treatment of infectious diseases in general by the
inoculation of the patient with the product of the dead bodies
of the micro-organisms of the same species that has caused
and is maintaining the morbid process in the organism.

And in particular as in tuberculosis, it is the injection of

396 FIFTY-FIFTH ANNUAL SESSION

the specific product of the tubercle bacilli — tuberculin — in a
definite manner and proper does whereby we get active im-
munization and the disease is healed.

This method consists, essentially, in the exploitation and
increased activity of the protective machinery whereby the
antibacterial power of the blood is increased to such degree
as to successfully protect the organism from further invasion
of pathogenic organisms and the deleterious effects of their
toxins.

Two elementary contents of the blood necessarily come into
consideration as protective agents against the invading micro-
organisms : "The leucocytes constitute one of these, and the
antibacterial substances in the blood constitute the other."

It is true that to Metchnichoff belongs the discovery of the
phagocytic power of the blood, and Koch discovered the prin-
ciples to a great degree of tuberculin therapy, but it was left
to Almoth G. Wright to show to the world lioiu and ivhy pha-
gocytosis is accomplished in bacterial diseases. This he has
done in a most lucid manner in his exposition of the opsonic
index, whereby the amount and power of opsonins in the
blood fluid may be estimated.

What then is ' an opsonin ?

It comes from the Greek word "Opsone;" "I convert into
palatable pabulum," or "I prepare the banquet."

Opsonins are substances — antibodies — formed in the blood
fluids which prepare and render mice- organisms susceptible
of being ingested and digested by the leucocytes.

The technique by which the amount of opsonins present in
the blood may be determined need not be repeated here, but
suffice it to say that it is the chemical union between the op-
sonins contained in the blood plasma and the pathogenic or-
ganisms that renders the latter acceptable to the white blood-
cells. Therefore the gauge to phagocytosis does not depend
on the activity of the leucocytes but upon the quantity and
increased power of opsonins in the blood fluid. Wright says :
"Increased phagocytic response is associated with successful

]Sr. C. MEDICAL SOCIETY. 397

immunization or cure, and this increased phagocytic response
is dependent on an increase of the opsonic power of the blood
fluids and not on the increased capacity for spontaneous phago-
cytosis on the part of white corpuscles."

I^ow, if these things are so, if the machinery of immuniza-
tion is understood and correctly interpreted by Wright, there
ought to be a better way of measuring the immunizing effects
of vaccine than by the old method of test inoculation of ani-
mals,

Wright and Douglas have clearly demonstrated that by
placing in a pipette an equal quantity of serum to be tested,
of blood-cells and of bacillus emulsion, and incubating for
twenty minutes the contents of the pipette, then straining and
examining under the microscope the average number of ba-
cilli taken up by the leucocytes may be accurately counted.
This gives the "phagocytic index."

The opsonic index is obtained by comparing this phago-
cytic index with that of healthy subjects.

1. We learn from these experiments that the serum pro-
foundly influences the phagocytosis ; that the increased power
of the serum depends upon the opsonins therein contained.
In short, the whole experiment teaches that the changes which
are associated with the acquirement of immunity are changes
in the blood fluids and not in the white blood-cells.

2. We learn that the "phagocytic reaction of the leucocytes
and the contents of the blood in antibacterial substances can
be measured with a degree of accuracy sufficient for all prac-
tical purposes." And if by these methods it is possible to
measure the changes by charts and curves showing the nega-
tive and positive phase in each, which are superinduced by
bacterial inoculation, it must be possible by curves to gauge
in a more accurate manner than by a test inoculation the im-
munizing effects of a vaccine, and what should be the doses
in any given case.

We have not time to go into a detailed account of the curves
of immunization, which are obtained by inoculation of tuber-
culin vaccine, and the laws which govern the output of the

398 FIFTY-FIFTH ANNUAL SESSION

opsonins, but we should learn in a general way that the op-
sonic index varies very little in a healthy man, from day to
day, but in tuberculosis the index fluctuates considerably.
That the depressions or "negative phase" is due to a natural
inadequacy of the organism in her protective machinery of
immunization or to the overwhebning doses of tuberculous
matter by auto-inoculation. That the positive phases result
from auto-inoculations or artificial inoculation just sufficient
to act as a stimulus, and that the essence of the vaccine
therapy consists in so timing and graduating a series of in-
oculations as to perpetuate the positive phase at high tide,
and therefore maintain the antitoxic activity of the organism.

Up to the present we have been dealing only with the physi-
. ology of immunization showing how the opsonins are per-
formed in the blood; that they are not bacteriloisins, ag-
glutinins or antitoxins ; but are the physiological products of
the tissues of the body, and are in the highest degree a specific
whose special function is to render all bacteria fit for inges-
tion and digestion by the leucocytes, whereby the immunizing
response is increased.

If w^e successfully treat the bacterial diseases by this
method something more is to be learned. We should know
how the bacteria find lodgment and growth in the tissues. We
should understand how bacteria or their product find their
way from the focus of infection into the blood stream; how
the organism reacts to auto-inoculation and how to bring the
baeteriotropic substances and leucocytes into action upon bac-
teria, which are cultivating themselves in the body but out-
side of the blood stream.

We know, therefore, that the rational application of this
treatment can be had only in strictly localized processes,
wdiere the focus of infection is cut of! from the lymph and
blood streams. This class comprises almost all chronic infec-
tion, including all localized tubercular process and early pul-
monary tuberculosis. In this class the opsonic index is per-
sistently low, owing to the absence of the immunizing stimuli.
In the formation of tubercle there is lowered vitality in the

N. C. MEDICAL SOCIETY. 399

focus of infection caused by absorption of the bacteriotropic
substances by the tubercle bacilli ; and because there is a de-
ficit of antibacterial substances in the focus is owing to the
fact that their conveyance through the lymphatics is greatly
hindered by the barriers thrown up and around the tubercle
in the form of a fibrous capsule.

JSText in order we must notice the general principles which
should underlie all our therapeutic measures: (1) "We
must provide for the conveyance of bacteriotropic substances
into the focus of infection"; (2) "In case there is stagnant
fluid in the focus of infection, which prevents the entrance .■»f
bacteriotropic substances from entering the infected area, we
must draw off the fluid in the focus."

One way the antibacterial fluid can be drawn fresh from
the blood stream through the lymphatics into the focus of in-
fection is by the application of heat or by Bier's method of
statis-hypersemia, which is effected by backing up the blood in
the veins which increases the hydraulic pressure in the cap-
illaries. This is effected as we know by the application of
elastic bandages to the parts in such a manner as to cause con-
gestion in the focus of infection, thereby carrying more —
an excess — of antibacterial substances to the bacteria, which
by increased leucocytosis are destroyed and the disease is
healed. This method controverts the old method of treatment
of inflammatory processes in the limbs and joints by rest, ice
and elevation. Willy Meyer, of Post Graduate, 'New York,
in a recent article speaks in the highest praise of this method
of treating tuberculous joints and limbs. He says: "Of
course hypersemia is not a panacea, but experience has shown
that this conservative treatment is by far the best method of
treatment at our disposal for the treatment of tuberculous
joints and bones."

To corroborate Meyer and others let me quote from Bier's
book, in which it is stated that in seventeen consecutive cases
of tuberculosis of the wrist treated at his clinic fifteen, or 88
per cent, were cured of tuberculosis. Of the elbow, 72 per
cent ; and of the foot, 61 per cent resulted in a cure. The very

400 FIFTY-FIFTH ANNUAL SESSION

hypersemia we have all along been combating with our ele-
ments of rest, ice and elevation, he now teaches as being a
teliologic factor — a wise arrangement of nature — in its fight
against an invading foe, which has not to be reduced but in-
creased in order to check the infective process and its deleteri-
ous results. "He certainly has demonstrated beyond the
shadow of a doubt that his method is far superior to those
formerly in vogue."

In the second instance, where there is an accumulation of
stagnant fluid in the focus of infection as in tubercular peri-
tonitis, the indications are for operative interference, by
which we achieve many times wonderful results ; but it is not
the surgeon's knife that does the good, but it is the access
gained by the bacteriotropic substances to the infected bac-
teria which will inhibit their further growth and cause their
destruction. In other words, we have an artificially induced
auto-inoculation.

ISTow, in regard to inoculation of bacterial vaccine or tuber-
culin for tuberculosis:

If as it is admitted that the reason every case of tubercu-
losis is not cured is on account of a deficiency of antibacterial
substances — of an opsonin — in the blood; can this be rem-
edied, and how ?

This was the great problem that concerned Professor
Wright, and he has apparently solved it by the renascence of
a once discredited method which, illumined by his own genius,
bids fair to become one of the most valuable assets in medi-
cine. And that method is nothing more nor less than Coke's
method of treatment by tuberculin or by the watery extract
of Von Euck. Coke's method failed because the requisite
knowledge did not exist for its intelligent administration.
"The main thing, the dose prescribed, was enormously too
large and given too frequently, and through the union of the
opsonin with the tuberculin terribly reduced the patient's
power of resistance to the infection within him."

Under Coke's treatment from five to ten milligrams were
given; whereas, Wright administered as a dose only 1-1000

IS". C. MEDICAL SOCIETY. 401

of a xnilligram. We knew iiothiug tlien of the opsonic index
or negative or positive phase : that the giving of an injection
during the negative phase would still increase further that
negative phase and drive the resistance down to zero ; but now.
thanks to Wright, a new era has dawned in bacterio-
therapeutics whereby it is made possible to administer tuber-
culin and other vaccines in an intelligent and safe manner,
both in diagnosis and treatment.

Wright, in speaking of single species of micro-organism
found in the body when giving his personal experience of
vaccine therapy, goes on to say: ^'Typical examples of this
type are found in cases where tubercle bacilli have effected
lodgment in lymphatic glands. In this type of infection all
but uniformly successful results have been achieved in my
experience by vaccine therapy. * * * W^hat applies to tuber-
culous infection of lymphatic glands applies also to tubercle
infections of the kidneys and other urinary organs, and also to
early cases of tubercle of the lungs."

The fundamental facts demonstrated by Wright and Doug-
las supply a firm basis for the extension of the therapeutic
lines in a definite and scientific manner; whereas, before it
had been entirely tentative and fraught with risks. By this
treatment Wright seeks to obtain the maximum amount of
protective substances from the minimum inoculations, and
he found that doses held by Koch and his disciples to be mod-
erate were more toxic than curative, and produced the nega-
tive phase. The positive phase, which lasts about two weeks,
is strongest when produced by tuberculin injections in in-
finitesimally small doses without producing any constitutional
disturbances — 1-1000 to 1-6000 milligrams ; but Koch taught
til at five milligrams were the proper dose — 5,000 times as
much !

Urwick, who so lucidly expounds Wright's theory sums up

the w^hole question by saying: "As the attempt to free the

organism from the bacteria by antiseptics is recognized to be

hopeless, the only other chance we have of destroying them is

402 FIFTY-FIFTH ANNUAL SESSION

by the injection of vaccine which forms protective or, in
the language of Ehrlick, "bacteriotropic substances."

In conclusion, I have refrained from entering into detailed
statistics but have confined myself to the discussion of the
main principles of vaccine therapy, hoping that by any means
we may here and there induce a scientific worker to embark
on this task of mastering this somewhat difficult technique
which shall vindicate the efficacy of vaccine therapy.

Although this is a new and practically untried method with
the general practitioner, yet the opsonic theory has demon-
strated that tuberculin as a therapeutic remedy in tubercu-
losis has passed beyond the experimental state, and rests on
the firm basis of clinical as well as therapeutical facts. In
regard to this treatment Trudeau lately states that in tubercu-
losis the more chronic the type of the disease the bettor
adapted to tuberculin treatment the case seemed to him, and
that in all cases of the common type, whether incipient or of
long standing and advanced, provided the nourishment was
good, will derive more or less benefit from tuberculin inocu-
lation. This utterance, coming from such high authority as
Trudeau, who is so conservative and not, until lately, an en-
thusiastic advocate for this treatment, speaks volumes for
tuberculin therapy.

For eight years I have been treating tuberculosis more or
less with the culture products of the tubercule bacillus, either
in the form of old tuberculin or of watery extract. The re-
sults in incipient and moderately advanced cases have been
eminently satisfactory. Even in advanced cases, with cav-
ernous softening where the bacilli were found in the sputum,
if nutrition were good and no complications the treatment is
beneficial and partial arrest of the activity of the infection
which is a decided advantage to the dietetic and open-nii
treatment.

It is seen, therefore, on every hand that the intelligent and
educated part of the profession in regard to this "opsonic
philosophy" is one of waiting, anxiety and extreme respect.

N. C. MEDICAL SOCIETY. 4:03

SOME OF THE ESSENTIALS IN THE TREATMENT
OF MODERATELY ADVANCED TUBERCULOSIS.

BY J. E. BROOKS, M.D., GEEENSBORO, N. C.

The title of this paper printed in the program is misleading
when it restricts the definition to incipient tuberculosis. In-
cipient tuberculosis is difficult to detect, and is generally
diagTiosed as something else. For this reason I wish to change
the title to read, "Some of the Essentials in the Treatment of
Moderately Advanced Tuberculosis." In this stage there may
be no pronounced impairment of function, local or constitu-
tional. Consolidation is not marked in extent, and there may
be no tissue destruction. The patient is at his work and con-
sults a physician because, in a general way, he is not feeling
well.

TREATMENT.

To be successful in the treatment the doctor must get entire
control of the patient and be able to direct his daily life. It
may not require a great while to build up and restore the con-
stitution to its original healthy appearance, but it may re-
quire months and years to cure or arrest a pulmonary lesion ;
therefore it is necessary at the very outset to put the patient
in the way of a life that he can and will live until his cure is
complete. Many patients fall by the wayside simply because
they are permitted to believe themselves cured as soon as
their weight and strength have returned. All tuberculous
patients when cured, if cured, are cured conditionally. This
should be drilled into them till the thought is ever present
with them. The success of the best treatment depends upon
its being kept up as long as the patient is in the flesh. There
is no longer debate about the ability of the consumptive to
get well, and yet no patient, perhaps, gets well and stays well
not conditioned upon good behavior. The wonderful success
of the outdoor treatment of this disease leads us to believe

404 FIFTY-FIFTH ANNUAL SESSION

that open-air life, with proper food and proper exercise, will
result in the cure of almost all moderately advanced cases;
that in the future, with properly constructed dwellings,
hygienic-dietetic living will eliminate the great white plague
from among men.

EXEECISE.

When the temperature is above normal exercise should be
prohibited. It is at this period that destructive tissue change
is greatest. Exercise now, even the afternoon buggy ride into
the country to get fresh air, causes rapid rise of temperature
increased heart-beat, loss of digestion with failure of appetite
and exhaustion. This is the time of all times to keep the
patient in bed and inhibit all effort. When there is no ele-
vation of temperature moderate and well-timed exercise must
be encouraged, but never to the point of fatigue. Probably
more patients are killed by misdirected exercise than by any
other manner of mistreatment. Exercise should increase with
a return to health.

THE SLEEPING CHAMBER.

The bed should be on the piazza with storm curtains to pro-
tect during the storm, but rolled up at all other times. When-
ever it is necessary to keep the patient in bed, let it be in the
open air. Keep him warm with light woolen blankets. The
open air causes sleep that is more refreshing, increases ap-
petite and digestion, quiets the nervous system, lessens cough
and gets the patient out of the way of taking cold.

DIET.

The consumptive must eat, and this must be taught as an
essential to recovery. A good stomach, good food, good diges-
tion and a good heart almost insure a successful termination.
The best diet for a consumptive is the one that causes a re-
gain of lost weight and gives the most strength to the body.
Solid food is better than liquid food. I shall not attempt a
bill of fare, but will stop at naming most of the essentials.
Pure beefsteak, plenty of pure sweet milk, roast beef, chicken,

N. C. MEDICAL SOCIETY. 405

turkey, fresh eggs, raw or cooked; butter, good bread, fresh
vegetables and fruits. These when taien in sufficient quantity
and well digested are in the main sufficient.

BATH.

A sanitary bath is necessary at least twice a week.

DRUGS.

I do not deny that drugs have a place in the treatment of
tuberculosis, but I do assert that no known drug affects the
course of the disease. Drugs that aid in the physiological
action of the organs of the body help in so far as they are
successful in that direction, but no further.

406 FIFTY-FIFTH ANNUAL SESSION

THE DIAGi\"OSIS OF ACUTE MILIARY TUBERCU-
LOSIS.

BY SILVIO VON KUCK, M.D., ASHEVILLE, N. C.

Acute miliary tuberculosis is a disease so varied in its clini-
cal manifestations, even independently of the distribution of
tubercle in the different organs, and in individual cases so
closely simulates other affections, that its diagnosis is often
attended by no little difficulty.

Especially is this true if the case has not been observed
from the beginning and when a reliable history is not avail-
able.

When the question of differentiation arises the history is
often of great aid, and a careful physical examination may
assist materially in the individual case, if the presence of an
old tuberculous focus be thereby revealed. In tuberculous or
so-called scrofulous persons, and in those who give a history
of previous tuberculous affections of internal organs, we should
not fail to inquire regarding the possible relation of trau-
matic influences. Again the appearance of suspicious symp-
toms in the course of several weeks after surgical operations
upon tuberculous bones and joints, lymph glands and othei
parts is suggestive of generalization of the tuberculous infec-
tion. In instances with a meningeal onset in young children
the coexistence of a chronic otitis or mastoid disease may
throw light on the cause of the symptoms.

In every case it should be borne in mind that we are dealing
with a secondary process which has its origin from a primary
focus somewhere in the body.

Although such etiological inquiries are important and may
assist greatly in making a correct diagnosis, especially in in-
stances in which tuberculosis is found, it is nevertheless es-
ential to avoid hasty conclusions, and this is particularly true
when the symptoms are atypical. Eor example, in young
children, though they have a tuberculous family Jiistory or

N. C. MEDICAL SOCIETY. 407

perhaps glandular tuberculosis, we may actually be con-
fronted with a broncho-pneumonia that has given rise to con-
vulsions, and to the undue rapidity of the respiration and the
pulse, which may reach a degree in generalized bronchitis
that equals or exceeds the frequency commonly observed in
acute miliary tuberculosis.

Thus the history of or presence of tuberculosis is but a link,
although an important one in the chain of circumstantial
evidence upon which we may base our final opinion, and this
is true of all symptoms, every one of which may have another
explanation when considered independently of the rest.

The respiratory insufficiency is one of the most constant,
and in the absence of physical signs which could explain it.
is one of the characteristics of the pulmonary form of the dis-
ease. When this has been preceded with the usual onset of
general malaise, loss of appetite, and the patient has at first
slight and then increasing dry cough, when we can exclude a
local lung affection or a pleural effusion, when there is no evi-
dence of a pericarditis or endocarditis, and the pulse is weak
and unduly increased in frequency, with or without the ir-
regular fever, the evidence becomes strong in favor of miliary
tuberculosis of the lung, and more so still if we have at the
same time support from an etiological point of view.

In such cases one will rarely err in the diagnosis of miliary
tuberculosis of the lungs, if the symptoms increase in intensity
and there is also rapid loss of weight. The latter is a promi-
nent feature in almost every case of acute miliary tubercu-
losis, and may be seen in instances in which the fever is of a
mild type and when a fair amount of nourishment is taken
by the patient. The diagnosis would still be supportable in
instances in which signs indicative of consolidation appear in
the lung in the course of the disease, and the sputum becomes
streaked w-x'v blood or actually becomes rusty for a time; nor
would intercurrent pleural pain or signs of an effusion require
its reconsideration. The later advent of more marked dysp-
noea with cyanosis still further strengthens the evidence and

408 FIFTY-FIFTH ANNUAL SESSION

the diagnosis is eventually established, even though none of
the symptoms are pathognomonic and etiological support is
lacking.

The physical examination of the chest shows, as a rule,
nothing characteristic, but can still aid us in certain cases.
The examiner may be confused in instances in which the af-
fection develops in the course of measles, whooping-cough or
phthisis when catarrhal affections belonging to the preexisting
pulmonary disease are present ; the more so if he has not him-
self been familiar with the local auscultatory phenomena prior
to the advent of symptoms indicative of a generalization. In
such cases the results of the physical examinations of the
chest are not available for diagnostic consideration, except as
a basis for estimating in how far they may be accountable for
the cough and dyspncea and the general condition of the pa-
tient.

On the other hand, records of or reliable information of
the recent chest examinations axe often of great value, in
cases where the former examinations have shown the disease
limited to certain areas, while other portions of the lungs
were free from catarrhal signs. When in such cases no change
is apparent or the catarrh appears to have become general-
ized, and especially when this is indicated by a sense of sticki-
ness, crepitant and subcrepitant rales, suggestive of bronchi-
olitis, the result of the chest examinations may give important
support to the diagnosis.

Early pleural symptoms, especially pain, are often men-
tioned in the description of cases. Juergenson^ described
a peculiar rubbing or a soft friction sound, without local pain,
which he noted in acute miliary tuberculosis, both on auscul-
tation and by palpation; this he attributed to the presence
of miliary tubercle in the pleura and which he and Litten
confirmed by finding corresponding tubercle at a „ opsy. Sim-
ilar observations have since been made by Burkhart," Hager,^
Riesman* and others who have noted this peculiar rubbing
in exceptional cases.

N. C. MEDICAL SOCIETY. 409

In the pulmonary form the early negative findings, or the
development of a diffused catarrh, the dyspnoea and increased
pulse rate are the chief features and may continue to be so
until the end unless meningitis develops in the further course.
The fever attracts often but little attention, although it is
rarely entirely absent. Careful observations should always be
made and the temperature should be measured in the rectum,
the dyspnoea and movith-breathing preventing the usual ap-
proximation to correctness of the mouth temperature. Fre-
quently we find that the fever which before has been absent or
intermittent has assumed an irregidar, remittent type, and
that the normal is not reached at any time during the twenty-
four hours, and occasionally an inverted type of the fever
curve may occur. The latter is, however, also observed in
other diseases, and is perhaps as frequent in acute pneumonic
phthisis as it is in acute miliary tuberculosis. When the
earlier course leaves us in doubt the subsequently increased
signs of pulmonary obstruction and of prostration, and the oc-
currence of delirium, the pallor, the continued emaciation
and, as already stated, the absence of physical signs to ac-
count for the dyspnoea aid in excluding other causes.

In differential diagnosis of the pulmonary form from
other affections of the lungs we have to consider more par-
ticularly pneumonia and bronchitis.

Broncho-pneumonia and acute capillary bronchitis, espe-
cially in young children, can cause great resemblance. Even
the prodromal stage may correspond in cough, slight fever,
loss of appetite, or the onset may be sudden in both affections
with convulsions. Henoch^ reported several cases of pneu-
monia of the upper lobes of children in which the symptoms
were suggestive of meningitis.

The respiration and the pulse can have an equal frequency,
and the fever may be equally high. The demonstration of
consolidation in the lung, and especially the presence of bron-
chial respiration, would be suggestive of pneumonia. If the
case has been seen from the beginning we have been able to

410 FIFTY-FIFTH ANNUAL SESSION

observe the dry stage of the catarrh to be followed by moist
rales, and have been able further to note its progressive ex-
tension from larger to smaller bronchi; this would likewise
speak in favor of pneumonia. A diffuse capillary bronchitis,
however, is in itself characteristic of miliary tuberculosis of
the lungs, and unless we have the aid of other symptoms, es-
pecially on the part of the nervous system, the diagnosis may
remain in doubt, or be shown in error at autopsy in cases that
are rapidly fatal. Such difficulties are not frequently en-
countered; the onset of miliary tuberculosis is, as a rule,
slower, and the physician is liable to see the case before the
pulmonary symptoms are developed to a degree that exudative
inflammations, in connection with dense deposits of miliai'y
tubercle, can resemble a pneumonic consolidation of the upper
lobes. Moreover such a complication in acute miliary tuber-
culosis is in itself very rare. The bronchiolitis caused by
miliary tubercle in the lung is, as a rule, preceded by increased
frequency of the respiration and by dyspnoea, and in the
earlier period the chest examination is either negative or the
inspiratory murmur in the upper lobes is markedly feeble as
compared with that of the lower, and when catarrhal signs
appear they develop in a reversed order, originating and ex-
tending from the smaller to the larger bronchi. We are there-
fore liable to hear first but few and later more crepitant or
subcrepitant rales in portions of the lung that are resonant
or hyper-resonant on percussion. In contrast with ordinary
bronchiolitis at this time the lower posterior portions are often
less involved than the upper, and there is no evidence of down-
ward extension of the catarrhal process unless by mere coin-
cidence, which may have been in a case observed by West®
of a boy nine months old who was seen two weeks after con-
tracting a cold and in which he diagnosed catarrhal bronchitis.
The child died six days later of dyspnoea and the autopsy
showed miliary tuberculosis of the lungs.

In adults acute croupous pneumonia is not liable to be mis-
taken for acute miliary tuberculosis of the lung, although

N. C. MEDICAL, SOCIETY. 411

when in the course of the latter typical rusty sputa appear
one would naturally think of the former. In such rare cases
exudative pneumonic foci are probably associated, but when
situated in the upper lobes they are suggestive of tuberculosis
rather than of ordinary pneumonia. The abrupt onset of
croupous pneumonia often with a chill, the regular fever and
the marked physical signs in the lower lobes, as well as the
general course and the appearance of the patient, differ
enough to prevent error.

Pneumonia and bronchitis in adults are more liable to lead
to diagnostic difficulty when occurring in aged persons, and
especially in persons who are otherwise decrepit. Very often
such affections begin insidiously and there is a gradual de-
velopment of dyspnoea, cyanosis and irregular fever, with local
signs of a diffused bronchitis; the illness is attended with
much prostration and general exhaustion, and leads to death
more or less rapidly. In such cases a generalized miliary
tuberculosis, which has followed a chronic or subacute type,
may be found unexpectedly at the autopsy.

A pleurisy with effusion could be thought of in cases in
which the miliary process of the pleura causes marked exu-
dation, and when the patient is first seen in this stage. It could,
however, be in rare instances only that a careful inquiry and
examination of a patient who suffers from acute miliary
tuberculosis would not exclude ordinary pleurisy as the cause
of all that can be found and observed in such cases.

Embolism of the pulmonary artery, when of small size and
involving numerous branches successively, or when in a larger
branch the obstruction develops gradually, may give rise to
symptoms which can correspond more or less with those
caused by miliary tuberculosis of the lungs, and death may
occur in the course of several days or weeks, with signs of
respiratory and circulatory insufficiency. ISTevertheless the
clinical picture differs and, even when such changes occur
gradually, the patient has experienced a more abrupt change
in respiration. At the same time his attention has been at-

412 FIFTY-FIFTH ANNUAL SESSION"

tracted to the disturbed heart action which occurs simultane-
ously and which continues forcibly, often with precordial
distress, while the small irregular pulse in connection points
to obstruction in the pulmonary circulation as the cause of the
dyspnosa and cyanosis. If the embolism is not of septic origin
there is no fever, and although the patient does not think of
the relation the physician would necessarily inquire and look
for phlebitis or appreciate the probable relation of a septic
affection, or of crushing injury to bone, etc., in the course of
which the accident has occurred.

In the typhoidal form the difficulties in diagnosis, in so far
as we seek to establish it upon symptoms, are liable to be
greater than they are in cases in which pulmonary or menin-
geal symptoms are prominent. In mgny cases the coexisting
symptoms of respiratory and circulatory insufficiency are im-
portant aids in differentiation from typhoid fever, and the
temperature curve and rapid emaciation are likewise liable
to direct the attention to the true nature of the disease.

However the resemblance in some cases which have been re-
ported has been most complete. Senator, among others, has ^-e-
corded such cases in 1881, in one of -which the autopsy showed
acute, miliary tuberculosis, although the type of fever, the
presence of splenic enlargement, roseola, distended abdomen,
dicrotic pulse, difficult hearing, epistaxis, singultus, and
eventually the occurrence of purulent parotitis all appeared to
speak for typhoid fever. But such cases are exceptional and
ordinarily the two diseases present striking differences which
can not escape the observation of the attending physician;
and even in the more irregular types a careful study of the
fever, pulse and respiration will in most instances enable him
to arrive at a correct decision. .

In acute tuberculosis the fever may be continuous with
scarcely any morning remissions. It is then more continuous
than typhoid and the typical typhoid curve is missing. In
other cases it is intennittent, the remissions are irregailar, or
it may be of inversed type, as has already been mentioned.

N. C. MEDICAL SOCIETY. 413

The pulse, as a rule, exceeds in frequency that which would
be in harmony with the existing fever, a fact which has been
pointed out by all obseiwers. In the fully developed disease
120-130 pulsations to the minute are not uncommon, and with
increasing pulmonary obstruction the rate may be increased
to 150 or more, even when the fever is comparatively low,

Increased frequency of respiration is noted at times quite
early, but it usually belongs to that period in which tubercles
have formed in the lungs. As the disease progresses the fre-
quency naturally increases, the respirations become gTadually
deeper, and a true inspiratory dyspnoea results. Even in
adults 40-60 respirations per minute are not unusual, and in
children this may be much exceeded.

The marked enlargement of the spleen as it occurs in ty-
phoid is rare in acute miliary tuberculosis, and a palpable
spleen speaks strongly in favor of the presence of the former,
especially in adults. A. Fraenkel,^ however, found that in
children the splenic enlargement may become equally marked.
Wagner^ and also FraenkeP have called attention to the
enlargement and pain on pressure of the liver in children
when this organ is included in the miliary dissemination.
Fraenkel has seen severe icterus, and in either children or
adults he believes an enlarged liver speaks for tuberculosis
rather than for typhoid.

When the correspondence of symptoms is complete the
question of differential diagnosis does not arise, but in general
practice where laboratory facilities are not available, such
oases still continue to afford occasional surprises upon the
autopsy table. When, however, such facilities are at hand,
we now have additional aids in bacteriological examinations
and serum reactions. Regarding the latter a characteristic
positive Widal reaction on the one side or a marked Arloiug
Courmont reaction on the other is rarely misleading, but it
must be remembered that tuberculous subjects often show a
Widal reaction, which, though less marked than in typhoid
fever, may cause confusion, and that the Arloing Courmont
test may prove entirely negative in tuberculosis.

414: FIFTY-FIFTH AISTNUAL, SESSION

In all doubtful cases in which the question of typhoid
fever centers into the dilferential diagnosis, bacteriological
examinations of the blood, urine and fjpces for the demonstra-
tion of Eberth's bacillus should be made.

From blood taken from roseola, Neufeld^*' was able to cul-
ture typhoid bacilli in 13 of 14 cases examined, generally
before a positive Widal reaction could be obtained, and
Curschmann^^ succeeded in the same way in 14 of 20 cases.

Besson,^^ on the other hand, failed in all but one case in
which he found Eberth's bacillus on the ninth day. This
author had likewise but negative results in examinations of
blood from intestinal hemorrhage, epita?is, and phlebitis, but
more recent blood examinations have generally been more suc-
cessful. Auerbach and Unger^^ succeeded in obtaining growth
in Y cases out of 10, by adding from 10 to 30 drops of the
blood to 300 cubic centimeters of bouillon.

Conradi" added oxgall to the blood specimens taken from
the finger tips or ear lobule to prevent coagulation, and to
assure better growth he added pepton and glycerine. In this
manner he obtained growth in 10 to 20 hours, and then plated
on agar. In 28 cases examined he was able to show Eberth's
bacilli in 22 and the paratyphoid form in 6 cases. In 8
cases he succeeded in the first week and in 5 other cases
before the Widal reaction was positive, or before typhoid
bacilli appeared in the fseces. Marchese^^ also obtained cul-
tures in 16 of 20 cases which he examined. VeiP® found
that a positive result is common in the first week, while in the
second week or later the bacilli can be found but rarely, and
then only in very severe cases. EdeP^ found typhoid bacilli
in the hemorrhagic sputum in a case of typhoid fever com-
plicated by pneumonia.

In the urine the bacillus of typhoid fever has also been
found with considerable frequency, although not as early as
in the blood.

Bouchard" examined the urine bacteriologically in 65 cases,
in 21 of which he found bacilli, which he considered identical

N. C. MEDICAL SOCIETY. 415

with those he found in the blood and presumably the organism
of typhoid fever. In all his cases the bacilli were found
only when albumen was also present. Karlinski^^ examined
the urine during life in 38 and the bladder after death in 6
cases. Of the 44 cases thus examined he had a positive re-
sult in 21 instances, and in some cases as early as the third
day. ]^eumann-° found that the bacilli appear in the urine
soon after the eruption of roseola, while Konjajeff^ found
them only in 3 of 20 cases in the third week or later.

Neufeld" found them in 3 of 12 cases, and Richardson"^
in 14 of 66 cases, but as a rule not until after the second week.
Schichold"'* was able to demonstrate the presence of bacilli in
one of his cases as early as the seventh day, and succeeded in
5 of IT cases examined. This author believes that structural
alterations in the kidney, either caused by the typhoid bacil-
lus or preexisting, must be present to allow their passage, and
that their appearance in the urine, and the time of their ad-
vent varies accordingly.

Wright and Semple"^ were able to demonstrate typhoid
bacilli in the urine in 6 of 7 cases, Jacobi^® in 7 of 30 cases,
and in a series of 100 cases examined- by Knox^^ the results
were positive in 51 and the earliest observation was on the
twelfth day.

In the faeces the typhoid bacillus has also been found with
varying frequency. Positive results were reported by Pfeif-
fer,^^ Simonds^^ and by Seitz,^" who found them in 6 out of
8 cases. Karlinski^^ in all of 9 cases, while Wight and
Semple's^^ examinations were, as a rule, negative. Pichai'd-
son^^ has contributed an excellent study to the subject and his
paper containfs valuable data as to the best methods to insure
success. He found the bacillus in 10 of 13 cases, as early as
the fifth, eleventh and twelfth day, while in the others they
were first detected after the twentieth day. Higley,^* who
succeeded in 20 of 21 cases, found them on an average as early
as the tenth day, while the Widal reaction appeared on an
average on the eighteenth day, and in the urine their earliest

416 FIFTY-FIFTH ANNUAL SESSION

demonstration was on the nineteenth day. In 36 cases since
examined by Krause and Sterz^^ were 19 positive results.

In cases in w^hich acute miliary tuberculosis occurs with or
soon after convalescence from typhoid fever, it may be mis-
taken as a relapse, especially so when the course of the pri-
mary disease has been typical and the diagnosis was well
established. In such cases great difficulty may be encoun-
tered when the symptoms are atypical, and the bacteriological
examinations just referred to avail nothing in the recognition
of the complication.

Unless the examination of the blood should again show
Eberth's bacillus or clear up the doubt by the presence of
tubercle bacilli, we must depend upon the analysis of symp-
toms, and the demonstration of choroid tubercle when menin-
geal symptoms are present, which suggest a basilar locali-
zation.

The diagnosis of the meningeal form of acute miliary tuber-
culosis offers less difficulty when meningeal irritation and in-
flammation occur, after characteristic pulmonary, with or
witliout typhoidal, symptoms have been observed in its earlier
course. In such instances the occurrence of meningitis, al-
though obscuring for the time the pulmonary affection, re-
moves, as a rule, any previous doubt, and confirms the tuber-
culous origin of the preceding symptoms as well as of the
meningitis.

Cases with meningeal symptoms have been observed in
which the onset and course Avere not sufficiently distinctive to
ex-clude tuberculous meningitis, and in which the differential
diagnosis, especially from typhoid with complicating menin-
gitis due to Eberth's bacillus, or from pneumonia with asso-
ciated pneumo-coccus meningitis, has at first proved more or
less perplexing. Our chief dependences for exact informa-
tion then are the specific sera reactions, the examination of
the fundus of the eye, examination of the spinal fluid, ob-
tained by lumbar puncture, and the bacteriological examina-
tions of the blood and secretions.

N. C. MEDICAL SOCIETY. 417

lu the ophthalmoscopic examination of the fundus, cho-
roidal tubercles have been found with various frequency,
but, as a rule, at such a late period that the nature of the
affection vras established on clinical grounds long before. In
rarer instances the discovery of choroidal tubercle has become
an aid in diagnosis. B. FraenkeP*^ reported such a case in
1869, in a child, age six, in which he found choroid tubercle,
although meningitis was absent; nor did it appear in the sub-
sequent course.

In a second case he found them ten days prior to the onset
of meningeal symptoms. Brueire" was able to make a differ-
ential diagnosis from typhoid fever and Loeb^^ succeeded in
the same way by finding tubercle of the choroid.

While the ophthalmoscopic examination is but rarely of aid
in the early period of the disease, and never in the initial
stage, the presence of tubercle of the choroid supplies abso-
lute evidence that more or less generalization of a tuberculous
process has occurred, and like the demonstration of tubercle
bacilli in the blood or the appearance of miliary tubercle upon
visible mucous membranes in the course of the disease, it re-
moves all previous doubt, in instances where the general symp-
toms justify the diagnosis upon clinical grounds only.

In cases in which meningeal symptoms occur early and
predominate in the prodromal and subsequent periods, the
slower onset and more protracted course speak for a tubercu-
lous origin. Such cases differ then but little from tubercu-
lous meningitis, without generalization, the consideration of
Avhich does not fall within the scope of this paper.

In cases of acute miliary tuberculosis, tubercle bacilli have
been occasionally found in the blood.

Weichselbaum^'' w^as the first to find them in the heart
clot of three cases which he examined, and at the same time
he succeeded in demonstrating their regular presence in the
miliary tubercle. Meissels*" confirmed Weichselbaum's au-
topsy findings, and he further found tubercle bacilli in one
of two cases examined during life. Lustig*^ also found tuber-
27

418 FIFTY-FIFTH ANNUAL SESSION

cle bacilli intra vitam in one case and in the heart clot after
death in eight others.

Eeutimeyer*^ demonstrated tubercle bacilli in the fluid
withdrawn with a hypodermic syringe from the spleen 16
hours before death, and Sticker/^ Doutrelepont** and Ulca-
cis*^ found typical bacilli in blood specimens taken from the
finger tips.

The last named authors were able to demonstrate them at
a time when the diagnosis between typhoid fever and acutt
miliary tuberculosis was in doubt. Tubercle bacilli have
since been found in the blood by various others by direct ex-
amination of stained specimens taken during life, but this
method frequently fails and the animal experiment is neces-
sary for their demonstration.

Most authors have failed to find tubercle bacilli in the
blood sufficiently early to render their demonstrations of
value in differential diagnosis. Nevertheless, Wild*® and
Kibbert*^ think that tubercle bacilli are present in the blood
more constantly than former examinations have indicated,
and they even believe in their multiplication in the blood.
The more recent observations of Jousset would in some re-
spects confirm these views.

Jousset,*^ by his method,* found tubercle bacilli in the
blood in almost half of the cases of acute and subacute phthisis

*Jousset's method, which is also applicable to pleural and peritoneal
exudates is for blood as follows: From 30 to .50 cc. of blood are
taken from a vein by means of a sterilized syringe, and diluted with
150 to 200 of sterilized water. After coagulation has occurred tlie
clot is filtered out upon a boiled compress and washed with sterile
distilled water to remove all serous fluid. It is then placed in a flask
to which are added 10-30 of artificial gastric juice ( 1 to 2 g. pepsin,
10 g. each of glycerine and hydrochloric acid, 3 g. of sod. fluorid and
1000 g. distilled water). The flask is placed in the incubator at 38°C.
or on the water bath at 50°C. for 2-3 hours, digestion being hastened
by agitating every half hour.

The resulting liquid is centrifugal ized and the sediment stained for
the bacilli.

To fluids which do not coagulate spontaneously or in the examina-
tion of urine, he adds a small amount of blood plasma from the horse.

N. C. MEDICAL SOCIETY. 419

which he examined. He succeeded in demonstrating them
with especial frequency in caseous pneumonia, and in two
cases he was able to make the differential diagnosis of acute
miliary tuberculosis from typhoid fever. The frequency of
his observations has, however, not been confirmed by other
authors, among them Bonardi/'' who, nevertheless, considers
the method of great, and even of as much value as the serum
reactions of Arloing and Courmont, and the tubercle test in
certain cases. Debove^" also thinks favorably of the method.

In the urine of a case of acute miliary tuberculosis in
which the diagnosis pointed to typhoid fever, Proebsting^^
found tubercle bacilli, and in the further course choroid
tubercle was also demonstrated. The autopsy in this case
showed caseous changes in the kidney, indicative of an older
lesion, Kleczetow^^ diagnosed acute miliary tuberculosis in
two cases by finding tubercle bacilli in the urine, and recom-
mends its examination in doubtful cases.

Baumgarten^^ and others have obtained positive results
from inoculations with urine, but for diagnostic purposes ex-
perimental tests with blood and urine are too slow.

What aid may be derived from the conjunctival administra-
tion of tuberculin as suggested by Calmette and from cuta-
neous administration, known as Pirquet's method, remains
to be seen. Bandler and Kreibish^* failed in obtaining a re-
action by the cutaneous method in four cases of miliary tuber-
culosis of mucous membranes, all of which had high fever
and were otherwise cachectic, which is in accordance with
Pirquet's own observation that miliary and cachectic cases do
not react.

Eyre, Wedd and Hertz^^ obtained a positive conjunctival
reaction in a case of tuberculous meningitis, and failed in
another in which the comatose stage had been reached 30
hours before death. On the other hand, Cohn'° found that a
reaction is frequently obtained in typhoid fever patients, es-
pecially in the stage of convalescence. Further observations
are necessary to establish the reliability of either method, but

420 FIFTY-FIFTH ANNUAL, SESSION

as they are unattended with danger and applicable in the
presence of fever, there can be no objection to their trial in
cases where the subcutaneous administration of tuberculin is
contra-indicated.

The urine shows nothing characteristic. It is, as a rule,
diminished in quantity, sometimes very scant, and Rosen-
stein^" has noted anuria in children, probably depending
upon implication of the kidneys in the miliary dissemination.
Slighter degrees of albuminuria are often present, and Mun-
ro^* noted albuminuria in 11 of 17 cases, which were con-
firmed by autopsy. Acute renal tuberculosis existed in over
70 per cent of these cases. In six cases without albuminuria
the kidneys were thus affected in but three instances.

The presence of indican especially in children, to which
Hochsinger called attention as of aid in differential diag-
nosis, and which Djouritsch^'' also thinks valuable in this re-
spect, occurs in other gastro-intestinal affections. Monti^"
found it only in very severe cases, and never in the begin-
ning, and other authors who investigated the subject in acute
and chronic tuberculous affections of children, as, for instance,
ISToute^^ and Steffen,*'^ attach no diagnostic import to its pres-
ence.

The diazo reaction, while not available for the differentia-
tion of typhoid fever, may be of aid in the diagnosis of the
pulmonary and the meningeal forms. JSTissen^^ found the
diazo reaction in 10 of 15 children suffering from acute
miliary tuberculosis, it having preceded the onset of meningeal
symptoms for a period of four to eight days in eight of his
cases.

Kephallinos*'* recorded the diazo reaction in 22 of 46
children with generalized miliary tuberculosis and coexisting
meningitis.

In certain cases in which acute miliary tuberculosis follows
its coiirse without distinctive symptoms, presenting the clini-
cal picture of some other disease, a positive diazo reaction
will be of diagnostic value ; for example, in such cases as re-

N. C. MEDICAL SOCIETY. 421

ported by Strauss,^^ Rlieinhold*'^ and others, in which before
death there were only symptoms of acute polyarthritic rheu-
matism, although the autopsy showed general acute miliary
tuberculosis. Rheinhold's case of a young woman, aged 18,
progressed under the symptoms of erythema nodosum with
rheumatoid manifestations, until symptoms of meningitis de-
veloped unexpectedly.

Other unusual clinical symptoms suggestive of septic pro-
cesses by the occurrence of well-marked chills at irregular
periods with great variation in temperature, or periods of
intermission will at times draw the physician's attention in
an entirely different direction, as shown by the cases reported
by Fischel" and by Spaeth,^^ in which acute miliary tuber-
culosis developed during the puerperium. Spaeth's case ap-
pears to have been complicated by a puerperal infection, but
in the case of Fischel there was no such evidence, and it is of
interest additionally, by an intermission of symptoms suffi-
cient to warrant the patient's discharge from the hospital.

In the foregoing consideration oif the diagnosis of acute
miliary tuberculosis there will be found nothing new or origi-
nal, but I have endeavored, in the light of present knowledge,
to review the subject as practically as possible in the time
allotted, and especially to emphasize the more important
points which are of real value in the differential diagnosis
from other affections.

Briefly these may be summarized as follows :

1. The rapid emaciation, which is a striking feature in
almost every case, and which is out of all proportion to the
degree of fever, the state of the digestive organs, and the
amount of food taken.

2. The bronchiolitis of acute miliary tuberculosis of the
lung is characteristic in that the catarrhal signs appear first
in the smaller and then extend to the larger bronchi, instead
of in the reverse order as in ordinary bronchitis. In further
contrast to ordinary bronchiolitis the lower posterior portions
of the lung in acute miliary tuberculosis are often less in-
volved than the upper.

422 FIFTY-FIFTH ANNUAL SESSION

3. Cases in which typhoid fever is minutely simulated by
acute miliary tuberculosis, or in which the two diseases co-
exist are rare, and a careful study of the pulse, temperature
and respiration will usually lead to a correct differentiation.

4. Serum reactions are reliable when present in well-
marked degree, but tuberculous patients may show a modified
Widal reaction, and the Arloing Courmont reaction is not al-
ways present in tuberculosis.

5. The ophthalmic test as applied by Calmette and the cu-
taneous application of tuberculin according to the method of
Pirquet, while not yet established as thoroughly reliable, are
safe, and one or both should be employed in all doubtful cases,
especially if the subcutaneous injection of tuberculin is con-
tra-indicated.

6. Bacteriological examinations of the blood, fseces and
secretions may be of great aid in doubtful cases.

7. The appearance of choroid tubercle, or miliary tubercle
of visible mucous membranes in the course of the disease re-
moves all doubt.

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sHenoch. Vorlesungen ueber Kinderkrankheiten, 2d Edition, 1883,
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cWest. Lecons sur les maladies des Enfants, 1875, p. 618.

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N. C. MEDICAL SOCIETY. 423

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33Krause and Sterz. Ztschr. f. Hyg., Vol. 44, 1903, p. 469.

36Fraenkel, B. Berlin klin. Woch., Vol. 6, 1869, No. 3, p. 37.

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ssLoeb, C. Arch, of Ophthalmology, Vol. 32, 1903, No. 5, p. 453.

39Weichselbaum, A. Wien. med. Woch., Vol. 34, 1884, No. 12-13:
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40Meissels, W. Wien. med. Woch., Vol. 34, 1884, No. 39: Centrbl. f.
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Vol. 6, 1885, No. 17, p. 294.

42Reutimeyer, L. Centrbl. f. klin. Med., Vol. 6, 1885, No. 21, p. 353.

43Sticker, Georg. Ibid, No. 26, p. 441.

44Doutrelepont. Deut. med. Woch., Vol. 11, 1885, No. 7, p. 98.

45Ulcacis, G. Gaz. degli Osped., 1885, No. 24, Centrbl. f. klin. Med.,
Vol. 6, 1885, No. 30 p. 517.

*6Wild, 0. Virchow's Archiv, Vol. 149, 1897, No. 1, p. 65.

4TRibbert. Deut. med. Woch., Vol. 23, 1897, No. 53, p. 841.

•isJousset, Andre. Trans. Internat. Congress of Tuberculosis, Paris,
1905, Vol. 1, p. 428, Muench. med. Woch., Vol. 52, 1905, No. 45, p. 2200.
Baumgarten's Jahresbericht, Vol. 19, 1903, p. 395.

4oBonardi. Gaz. degli Osped., 1904, No. 88; Centrlbl. f. Innere Med.,
Vol. 26, 1905, p. 433.

soDebove. Gaz. des Hop., Vol. 76, Mch. 10, 1903, p. 289.

424 FIFTY-FIFTH ANNUAL SESSION

siProebsting. Berlin klin. Woch., Vol. 21, 1884, No. 37, p. 588.

52Kleczetow, J. Muench. med. Woch., Vol. 51, 1904, No. 25, p. 1122.

ssBavimgarten. Baumgaiten's Jahresbericht, Vol. 2, 1887, p. 176.

54Bandler, V. Kreibich, K. Deut. med. Woch., Vol. 33, 1907, No. 40,
p. 1629.

55Eyre, Wedd, and Herz. Lancet, Vol. 2, 1907, No. 25, p. 1752.

56Cohn, S. Berlin, klin. Woch., Vol. 44, 1907, No. 47, p. 1507.

sTRosenstein. Pathologie u. Therapie der Nierenkrankheiten, 3d Ed.,
1886, p. 525.

ssMunro, J. C. Medical News, Vol. 55, 1889, No. 3, pp. 07-69.

59Djouritsch L. Rev. mens, des mal. de I'enf., Vol. 12, 1894, p. 49,
Schmidt's Jahrbuecher, Vol. 242, 1894, p. 162.

soMonti, A. Kinderheilkunde in Einseldarstellungen, Berlin & Wien,
1899, No. 9, p. 128.

siNoute. Rev. mens, des Mal. de I'enf ance. Vol. 2, 1893, No. 2, p. 49.
Schmidt's Jahrbuecher, Vol. 239, 1893, p. 43.

62 Steffen, W. Jarbuch f. Kinderheilkunde, N. F., Vol. 34, 1892, No.
1, p. 18.

ssNissen, W. Jahrbuch f. Kinderheilkunde, N. F., Vol. 38, 1894,
No. 2, pp. 145-185.

64Kephallinos, N. A. Wien. med. Woch., Vol. 55, 1905, No. 23, pp.
1145-1152.

esStrauss, H. Charite-Annalen, Vol. 24, 1899, p. 292.

66Reinhold, H. Deut. Arch. f. klin. Med., Vol. 47, 1891, No. 5-6,
p. 423.

6TFischel, W. Prager med. Woch., Vol. 8, 1883, No. 43, p. 421.

68Spaeth, F. Diss. Strassburg, 1885, p. 38.

N. C. MEDICAL SOCIETY. 425

USE AXD ABUSE OF DKUGS IN TUBERCULOSIS.

BY WILLIAM M. JONES, M.D., HIGH POINT, N. C.

To what and where are we drifting in our therapeutics re-
garding tuberculosis, and particularly that form known as
phthisis ?

Since the beginning of medical history, tuberculosis has
been attacked, from every known point, and by all kinds of
men, with as many different varieties of treatment as was
possible for the brain to conceive of. Why is it that we of
to-day have not profited more by the success or failure of our
predecessors ? Is it because of the fact that w^e have lost
sight of the minor considerations in our insane endeavor to
obtain a specific ? We know that this disease has been suc-
cessfully treated by men of the past, and that our results of
to-day are but a little more encouraging than those of an
hundred years ago.

By an examination of the history of the past few years, we
find that the favorite of to-day has invariably been the out-
cast of to-morrow. This has caused no small amount of dis-
trust for the use of drugs, and we stand ready to discard them
from our armamentum, and to rely entirely on climatic, di-
etetic and hygienic measures. That drugs are of value no
one can deny, although there may be differences of opinion
as to the position they occupy, when compared with other
methods of treatment.

The narrow scope of this paper will not permit me to enter
into any discussion other than the internal administration of
drugs, and in this I shall not attempt to discuss their physio-
logical action or to mention more than a few of the more fre-
quently employed, and confining my remarks in the main to
such data as I have gained from observation.

Post-mortem statistics present conclusive evidence of the
curability of this disease, when we remember that there is at

4:26 riFTY-FIFTH ANNUAL SESSION

least as great a per cent as 90 per cent to 98 per cent of all
persons who reach the age of 35 years, who show healed tu-
bercular lesions, we must infer that drugs have been instru-
mental to an extent in this restoration.

Caswell, in 1836, said: "Pathological anatomy has never
afforded stronger evidence of the curability of a disease than
in a case of phthisis."

Drugs used in tuberculosis are supposed to act in one of two
ways : directly on the tubercle bacilli, causing their de-
struction or prohibiting their growth and proliferation ; in-
directly by the increase of body weight and consequent in-
crease in strength and resistance of the patient. In regard
to the destruction of the tubercle bacilli there is no drug
or combination of such strength that will not at the same
time destroy the surrounding tissues, though some may have
the power to lessen their growth and proliferation.

Tuberculosis is seldom so pure and simple. By this I
mean to convey the idea that tuberculosis per se is rarely to
be found as the only pathological condition that is affecting
the patient; even in early incipient cases there is often a
mixed infection and slight leucocytosis with more or less
aniemia.

When we use the term abused we do so with the intention
of conveying the idea that it is contra-indicated, whether
from a physiological standpoint or one of idiosyncracy, or
on account of some complication that may be affecting the pa-
tient, and thereby contradicts its administration.

The first that we shall consider is cod liver oil. This is
a fixed oil obtained from the fresh livers of gadus morrhea,
or other forms of codfish. This drug, or food as it is some-
times called, has to the mind of the laity become almost
synonymous with tuberculosis, and to such an extent that
whenever a patient is taking cod liver oil the inference is
that he has consumption. In the administration of this drug
it will be found advisable to begin with a small dose and
gradually increase, using a few drops of ether to assist in the

N. C. MEDICAL SOCIETY. 427

digestion, and a small amount of ol, eucalyptos may be
added to disguise the taste. By this means patients will be
enabled to consume larger amounts and for a longer time
without the usual amount of digestive disturbances that so
frequently accompany its administration. The most that can
be said of it is that it is an easily assimilable fat, and as such
causes an increase in the weight and strength of the patient,
and thereby an increase in his resistance. We are aware of
the fact that the market is simply deluged with patent and
proprietary preparations purporting to contain from 40 to 50
per cent of oil, when in reality they seldom contain more
than 8 to 10 per cent, and this not always cod liver oil, but
some substitute. Many of these preparations contain alco-
hol, and are therefore stimulants and not nutrients. When-
ever this drug can be used without derangement of the diges-
tion or other inconvenience to the patient it is of advantage;
on the other hand, when the opposite effects are produced, it
is of very decided disadvantage, and its administration should
be immediately discontinued.

The same may be said of the other oils as of cod liver oil,
and cotton-seed oil is preferred by many on account of the
fact that it may be administered for a longer time and m
larger doses, without so much derangement of digestion and
little inconvenience as regards taste, and on account of the
fact that it may be administered during the hot months of
the summer.

Creosote, like cod liver oil, has become so fixed in the minds
of the public that they think that its only therapeutic use is
in tuberculosis. The creosote that is usually found on the
market is an impure phenol; and it is only the pure beech-
wood that should be used for internal administration. The
employment of creosote in tuberculosis was based on the
statement of Guttman, "that tubercle bacilli were destroyed
by blood containing one of creosote to 2,000, and that one-
half of that proportion would arrest their develpment." This
was only theoretical, for we know that what good effects are

428 FIFTY-FIFTH ANNUAL SESSION

derived from creosote are due to the formation of soluble
compounds between the remedy and the toxic albuminous by-
products of the tubercle bacilli which are eliminated by the
blood.

The carbonate of guiacol is preferred by some clinicians,
as it is the principal ingredient and of more definite compo-
sition.

Creosote was first advanced as a remedy in tuberculosis
by Richenbach in 1833, and revived by Gimbert and Bou-
chard in 1877 ; since which time it has been used by men of
reputation and ability, who have reported so favorably and
in so many instances that there is at least strong prima facie
evidence in favor of creosote and its derivatives. But we
must not lose sight of the fact that it is often the cause of
digestive derangements, and whenever this be the case its use
should be immediately discontinued. One specialist has said,
as regards the digestive derangements: "In the majority of
the «ases sent to me the digestive troubles may be attributed
to excessive doses of creosote which had been administered
by the family physician.

It would be an act of presumptuousness for me to attempt
to discuss the great disadvantage to. which a physician is
placed in his endeavor to treat a case in which the stomach
is weak and nonretentive to most of his remedies. N^ever-
theless this is a state of affairs or condition that we are often
compelled to face, and one that will tax our skill, patience
and ingenuity to the utmost.

Ichthyol (ammonia ichthyol sulphate). This, though a com-
paratively new preparation, was first brought to the attention
of the profession as a remedy for tuberculosis in 1894 by
Cohn and Scarpa, since which time it has been extensively
employed, and the results have exceeded the hopes and expec-
tations of the most sanguine.

It retards the disintegration of albuminoid substances and
favors their formation and assimilation, increases peristalsis
and has a laxative action on the whole intestinal mucosa. It

N. C. MEDICAL SOCIETY. 429

is excreted by the feces aud urine, but not directly, as it is
first absorbed and then excreted, this being verified by the
fact that from seven to ten hours are consumed in its elimi-
nation. It causes an increase in body weight, lessens cough
and alters expectoration from purulent to mucoid; stimulates
the digestion, thereby causing an increase in the appetite, and
lessens night-sweats. Though not very pleasant to the taste,
it is seldom the cause of nausea. It may be administered in
pill, capsule or emulsion, and should in all cases be well di-
luted with milk or water, preferably immediately after meals.
Of all drugs used in tuberculosis I consider this far the su-
perior, not alone from my own observation but from the re-
ports of well-known physicians and those of reputable insti-
tutions. It has been said "that the only objection to its use
was the cost."

A few words regarding the use and abuse of drugs when
used for special symptoms or complications.

It is in the management of cough that drugs are more
abused than in any other complication affecting a case of
tuberculosis. The patient complains that he is annoyed to
such an extent that he can not sleep on account of an harass-
ing cough, and seeks relief from this distressing condition.
In the majority of instances he is given some mixture con-
taining opium, or some preparation of a sedative and hyp-
notic character and possibly containing a little potassi iodide,
in a menstrum of syrup, that will mask the symptoms and
aggravate the condition. The cough may have been due to
some cardiac derangement, the terminal filaments of the
vagus nerve may have been irritated, an elongated uvula, in-
flammation of the eustachian tube from middle-ear disease
laryngitis, post-nasal polyp, etc. In the event that you are
unable to find the direct exciting cause of the cough, and it
is of such a character that its relief is imperative, a little
heroin will in the majority of cases be all that is necessary.
Antipyretics have no place in the treatment of tubercu-
losis as they only mask a symptom and do not effect a cure,

430 FIFTY-FIFTH ANNUAL SESSION

with consequent depression of the heart and that of the gen-
eral system. Rest absolute of mind and body will bring about
all the reduction that is necessary, and in the event that it
does not reduce it antipyretics are not called for.

Hemorrhage. — The drug most often used and one that some
of the recent text-books recommend is ergot. Ergot is of
value in hemorrhage of any organ with the exception of the
lungs, and here it is as surely contra-indicated, and more so
than any drug that I can at present call to mind. The reason
is that ergot is a stimulant to the vaso-motor centre, causing
a contraction of the small arteries and arterioles, and by this
action lessening the escape of blood, but at the same time
causing an increase in the arterial tension and raising the
blood pressure. The lungs, being separate and distinct in
their minute histological anatomy as to circulation, accounts
for this contra-indication in the administration of ergot. The
terminal branches of the pulmonary artery do not anastamose
as do the terminal branches of other arteries, and the walls
of the pulmonary vessels are much thinner and consequently
weaker than others, and as a natural sequence, whenever
the blood pressure of the entire anatomy is raised, these
wealcer vessels are the first to give way under the increase,
and the condition is thereby aggravated.

Rest combined with small doses of atropine will generally
stop the flow in a short time.

References : Sajou's Cyclopedia, Potter's Therapeutics, Wood's Thera-
peutics, Butler's Mat. Med., Nothangel's Encyclopedia. Kirk's Physi-
ologv.

. N. C. MEDICAL SOCIETY. 431

OUTDOOR LIFE FOR THE PREVENTION AND
CURE OF DISEASE.

BY PAUL PAQUIN, M.D., ASHEVILLE, N. C.

You mention outdoor life to the average patient and he or
she begins at once to sniff fresh air and to have visions of trees
with birds flying about, flowers of various hues and aroma,
expanses of prairies, hills, mountains and valleys, streams,
rivers and oceans, shooting, hunting, fishing, tenting, shacking
and roughing it in general. Just about so with the average
medical man, for few of the profession have had experience
with the problems involved in this proposition, or have given
any thought to them. In fact, all that the sentence "outdoor
life" conveys to the vast majority of civilization is a vague
idea of trying to return to the ways of nature for help when
in physical distress by disease. That the work of civilizing
humanity has wrought radical changes in the habits, require-
ments and resistance of human beings and brought them to
habits of life so artificial and foreign to original natural prac-
tices as to create second natures, so to speak, scarcely ever
enters the mind of anybody. Consequently the requisites for
safe and profitable outdoor life need to be discussed and
studied if we would apply it in the prevention and cure of
disease ; and; as a preamble, I do not hesitate to say that reck-
less and haphazard outdoor life is no more justifiable than
rtckness and haphazard drugging. Both have had in the
past and have to-day graveyard consequences.

Outdoor life goes back to primitive ages for its inspirations
and ideals. The student of nature has discovered that certain
maladies, particularly tuberculosis, is a disease of civiliza-
tion. He has established that the wild man in the woods and
jungles is seldom tubercular in his natural home in the open,
and becomes involved by contact with civilized humanity.
And so the consumptives and their medical advisers prescribe

432 FIFTY-FIFTH ANNUAL. SESSION

outdoor life, which is welL But pause and consider. Don't
push a sick man, woman or child out of doors in ignorance
of individual conditions, circumstances and susceptibilities.
As a rule the majority are not ready to cope instantly with
and be benefited by the influences of outdoor life in all its
forces and moods.

Housing, clothing and inheritance have turned man from
wild ruggedness into a hothouse plant not always to be ex-
posed without prior preparation to certain atmospheric and
climatic conditions, with impunity. You should not expect,
for instance, that a man who comes to you as many do with
an overcoat in the month of June, thick coat and vest under-
neath, a thick flannel shirt under these, one or two or three
undershirts, then a chest protector as dense as cowhide, and
finally, the skin bound down by sticking plasters — you need
not expect, I say, that such a man, stewed in the sweat and
filth of his own body, can be suddenly laid out in the open
air night and day without some sort of dangerous reaction.
The best plan to catch a cold and also for the pulmonary
sufferer to develop a pulmonary congestion is to sweat and
then be exposed to a sudden process of cooling. This is only
one way, however, to cause damage by outdoor life. There
are many others, and so we need to understand them in order
that we may not cause more harm than good in forcing pa-
tients to live out constantly.

As fundamental forces for beneficial outdoor life we may
point out, above all things, the persistent supply of oxygen
with the persistent dissipation of carbonic acid gas without
rebreathing it, as compared with the more or less impover-
ished oxygen supplied in a room, and the constant rebreathing
of the carbonic acid gas emanating from the lungs; and then
the breathing of air from the house dusts and the dangerous
germs of carpets, crannies and darkness, for in the open air,
in favorable localities at least, the germs that float about and
which when inhaled might do harm if they had been pro-
tected within a building, are comparatively harmless after

jSr. C. MEDICAL SOCIETY. 433

having been subjected to tlie influences of sunlight, rains
and other atmospheric conditions. These basic factors are
the essentials for the prevention and cure of disease by out-
door life. Thev are immensely valuable contributions to
complete nutrition, which is the very soul of health. iSi^ow,
how are we to maintain safely their good influence about a
l^erson, brought more or less out of close communion with
nature by ages of ancestral artificial existence and by indi-
vidual artificialism and false methods of the present day civ-
ilization ?

To begin with, we must educate each person, if found
necessary, in a manner to restore as nearly as can be normal
personal existence as to clothing and exposure to the various
elements of the atmosphere. A person who overdresses and
macerates his or her skin with perspiration must, first of all,
be gradually relieved of the encumbrance and made to live
and to remain dry and to become capable of resisting the
coolness of the breezes at least, not to say anything about
accidental drafts and winds which all humans at times must
be prepared to meet. A person must also be taught that cold
weather, rains, snows, etc., are not insalubrious — far less than
heat perhaps — but that certain conditions affecting these or
the persons subjected to them are damaging; for instance,
high winds, storms, direct drafts, sand or dust blowing, etc.,
etc. Above all things, those persons who think that they pro-
tect themselves from cold by keeping wrapped up in shawls,
coats, sweaters, blankets, etc., as suggested above, and who
insist, either of themselves or through friends and relatives,
in living day and night in heavy underwear in order to keep
off colds, should be taught and made to realize that this sort
of so-called protection is a trap to catch colds and congestions
and all the attendant catarrhs, and that underwear is pri-
marily to keep the skin and necessary clothing far enough
apart to maintain a free ventilation all around the body.

On the other hand, the question of sleeping in or out of
drafts, of being close to or far above ground, of getting wet
28

434 FIFTY-FIFTH ANNUAL SESSION

and chilled, or suddenly hot after being cold, of rising at night
when sleeping out, are to be considered by doctors and pa-
tients, particularly those who preach tents and shacks with-
out ever thinking of surroundings, arrangements and ap-
pointments thereof.

In lying down, night or day, one can not afford to be in a
direct draft that strikes only a part of the body. Be it ever
so slight, it chills that part more or less, and, except perhaps
when the draft hits the face alone, I assure you that usually
a cold results. A breeze or light draft that is not seriously
chilling in its temperature, and which covers and surrounds
all the body alike, is not likely to cause a cold or congestion.
The whys and wherefores of these facts can not be discussed
in this brief paper. Suffice it to assert them.

It is evident, then, that one who would live out night and
day must be so situated as to be bathed constantly in fresh
air with the minimum chances of being subjected to drafts. I
need not say, of course, that equal protection against chilling
winds and rains and snows must also obtain. How can these
desired results be secured ? Simply by good common sense
selection of a locality to live in and proper arrangements to
live out.

First. — Select a fairly high altitude as far from smoke and
road dust as possible.

Second. — If you choose a shack or tent have its floor sev-
eral feet above ground, and be sure that it is lavishly venti-
lated (without direct body drafts), for a shack or a tent of
the usual kind is a fraud and a snare, and worse than an ordi-
nary bedroom with open windows. For one thing, a canvas
room is usually stuffy and hot, and then it is generally too
close to the ground and absorbs earth moisture with rheumatic
and congestive effects.

Third. — ^You might roost up a tree by arranging there some
sort of hold-on-to-platform and overhead covering. This sug-
gestion has been laughed at, but still it offers opportunities
for profitable fresh air life undreamt of by the sick or the

N. C. MEDICAL SOCIETY. 435

profession. It has been tried, too, and found less wanting
than most any other outing abode.

Fourth. — By far the most satisfactory arrangement is the
specially devised outdoor living and sleeping rooms, called
the "in and out sleeper," whereby one may lie day and night
absolutely and completely in the open, surrounded by fresh
air always, without any danger from drafts, rains, snows,
winds, dusts, etc. This is the method presented last year to
the section of hygiene of the American Medical Association.
This system obtains to-day at the Asheville-Biltmore Sani-
tarium. No weather was ever found bad enough to do the
least damage to guests in such quarters. Through the winter,
in dry and wet weather, everybody slept out. A special draft
system at the foot of the bed draws the air past the body
without touching it, keeping fresh air through and through in
constant circulation, and then a foul air flue system carries
the foul air of the rooms to an exit on top of the roof of the
building.

In conclusion let me suggest that, after all, outdoor life is
merely an aid to suitable nutrition, which is a process that
involves not only the use of food and water, but the fullest
possible assimilation of all the elements necessary to main-
tain the equilibrium of physical and mental forces in man,
which we call health.

436 FIFTY-FIFTH ANNUAL SESSION

IMPORTAJSTCE OF EAKLY DIAGNOSIS 11^ SUC-
CESSFUL TEEATMENT OF TUBERCULAR AF-
FECTIONS.

BY DANIEL A. DEES, M.D., BAYBORO, N. C.

In presenting this paper on the importance of early diag-
nosis of tubercular affections I have nothing new to offer, but
want to call your attention to something that is known by
every well-informed physician, though grossly neglected by
a great many. We have no disease at the present time that
is of more importance or of more interest than that of tuber-
culosis, especially pulmonary tuberculosis, though what is
said of this form might apply to all varieties.

A great deal is written concerning the prevention and cure
of this terrible disease so mild and sneaking at the beginning,
yet so disastrous in its results. Our text-books and journals
are filled with literature on its prevention and treatment, and,
strange to say, there are so many of our physicians who fail
to diagnose it early, and often wait so late before detecting-
it that all hope of arresting or curing the disease is lost. This
is not due to ignorance on the part of the practitioner of med-
icine, but is for the want of care and the lack of important
symptoms of the disease when infection first takes place.

The majority of our tubercular patients have to remain at
home for treatment, and must take their chances to live or die
without a change of climate. A few there are who have the
means to go to any place where possibly the climatic condi-
tions might agree with their special case, but the former class
has a magnificent chance to regain their health at their native
homes provided an early diagnosis is made and proper in-
structions given them as to diet, etc. As it is a w^ell-known
fact that while certain climates help and are very beneficial,
nevertheless a man can get well in any climate if he starts in
time and takes the proper kind of treatment.

* N. C. MEDICAL SOCIETY. 437

Some of our patients we send to different sections of the
country and put them under the care of men who make a
special business of treating this one disease, and the results
in cases that are sent early are very gratifying indeed. But
our mountain friends tell us that many cases go to them too
late for successful treatment, either so far advanced that noth-
ing for patient can be done, or that patient remains at a stand-
still for months and months before any improvement does
take place. This should not he, and the responsibility for
changing such conditions rests upon the medical profession.

At the present time our equipment is far superior for diag-
nosis of the disease early than it was years ago before the
discovery of the bacillus tuberculosis. There are other means,
but the microscope is the average man's early detective and
it should be used more than it is. The time has passed when
it is necessary for a cavity to be in the lung before a positive
diagnosis of tuberculosis is made, and yet some patients get
that far advanced before a positive diagnosis is made.

Many of us, especially those who practice in malarial dis-
tricts, have had patients to come in office with history of slight
chills, anorexia and general ansemic condition, and attribute
it to malaria, give usual treatment and not see patient for
weeivS to find on next visit to office that patient has all the
symptoms of tuberculosis. The same might be said of typhoid
fever and some other diseases.

Unlike a great many other diseases tuberculosis requires
an early diagnosis if Ave expect to get results by treatments
that are so greatly desired. To accomplish this we have to
rely chiefly upon microscopical examination of the sputum
more than anything else. This is absolutely essential to make
a real positive early diagnosis, and we can not lay too much
stress on that one thing.

There is a great deal said concerning the prevention of this
disease. To my mind the greatest factor in preventing it is
to diagnose early the cases which we already have and thereby
prevent one patient from inoculating a whole family or com-

438 FIFTY-FIFTH ANNUAL SESSION *

mimity. In an early diagnosis we give to the patient the best
possible chance for getting well, because an early treatment
usually gives very satisfactory results. The patient soon be-
comes educated, so to speak, as to their own protection and
the protection of others with whom they come in contact.
Early detection of the disease with immediate treatment
promises the individual patient good results. It protects the
immediate family by causing the proper hygienic measures
to be inaugairated, and therefore it protects the community
as a whole, hence lessens the prevalence of the disease.

To me there is no medical subject of more importance than
tuberculosis, and when we recall in every community whole
families who have died from this disease we realize there
are causes, and one cause is the neglect of early diagnosis of
the- trouble and thereby protecting those who are well. As a
profession it behooves us to educate the laymen as to its dan-
ger and at the same time be on the lookout for incipient tuber-
culosis and see if the mortality of this disease can not be les-
sened.

X. C. MEDICAL SOCIETY, 439

A REPORT OF CASES TREATED WITH ICHTHYO-
LATED EMULSIOX COMPOUXD.

BY JOHN BOY WILLIAM:?, M.D., GBEENSBORO, N. C.

Ichthyol, as a valuable adjunct in the treatment of tuber-
culosis, has been recognized for over twenty years. It has
not been used as largely however because of its disagreeable
odor and taste. Heretofore it has been prescribed in aqueous
solution, in capsules or as the gelatin-coated pill.

It is a recognized clinical fact that ichthyol improves the
digestion and assimilation, with little or no irritation of the
gastrointestinal mucous membrane if carefully applied. It
lessens tissue destruction, especially the albumins, as shown
by diminished nitrogenous excretion; it increases the flesh
and strength by increasing the appetite, digestion and assimi-
lation, thereby lessening the outgo and increasing the income.
It is eliminated chiefly by the kidneys in the form of sulphur
compounds, acting as a diuretic. It constricts the capillaries,
improving the general circulation. Tends to rapidly convert
a purulent sputum into a mucoid sputum, making it more
fluid and easily raised, improving the drainage from the dis-
eased foci and lessening the absorption, which is the chief
cause of rapid heart and fever. It often rapidly reestablishes
the menstruation in tubercular anaemic women, and the night-
sweats in most cases soon stop. It improves the nutrition of
the heart through its constricting action on the coronary ar-
terioles and indirectly, through its several physiological ac-
tions, lessens blood destruction and assists in building up the
same.

^Potter says: "The particular value of ichthyol is due to
its nonirritant quality and the large proportion of sulphur
contained therein. It retards the disintegi'ation of albuminj^
and favors their formation and accumulation."

"Bartholow says: "It increases assimilation and hinders
retrograde inetanior])hor;ic, wherebv the nntriti.m is improved

440 FIFTY-riFTH ANNUAL SESSION ,

and the body weight is brought up to the normal leveL Has
a decided antiseptic action and is fatal to pathogenic organ-
isms. It increases the volume and force of the circulation.
Has a remarkable power to check waste, the urinary solids
and nitrogenous excretia being greatly diminished. Hence,
under its administration, the body weight increases, the in-
come is promoted and the outgo is lessened, and these impor-
tant results are accomplished without in any way impairing
digestion or irritating the gastro-intestinal mucous mem-
brane."

^Cohn says : "It increases the strength of the organisms
and places itself in a favorable position to carry on a success-
ful warfare against the bacilli of tuberculosis. In advanced
cases improvement often follows when cod-liver oil and creo-
sote have failed."

*Branthomme says: "He considers the action of ichthyol
similar to creosote, but without the disadvantages of the lat-
ter. It is less irritating to the stomach than creosote, dimin-
ishes exjDectoration, causes an increase in weight, improves
the general condition of the patient, and restores menstruation
in tubercular ansemic women."

^Combemale and Desoil report that "during fourteen
months all tubercular patients at the Charite Hospital at
Lille were treated witli ichthyol. There was prompt im-
provement in the general health of the patients, as manifested
by the disappearance of the night-sw^eats, gain in weight and
strength, and a reappearance of the menses. The expectora-
tion is almost invariably lessened in amount and made more
fluid, so that coughing is easier."

''Stubbert reports that "of all drugs used in the Loorais
Sanitarium at Liberty, ]^. Y., for phthisis, ichthyol had
yielded the best results. Under its influence the sputum was
more easily brought up, became less yellow and more of a
mucoid appearance. There was amelioration of chills, sweats
and fever."

'^Williams says "he has used ichthyol in several hundred

N. C. MEDICAL SOCIETY. 441

cases of pulmonary tuberculosis with good results in a large
majority of cases. He lias found the appetite and digestive
powers increased, the daily average of temperature lowered
and the sweats in most cases to cease. The bacilli rapidlv
show degenerative changes, with a gradual disapparance of
them from the sputum. The cough is modified, the expecto-
ration becoming easier, the sputum becoming more fluid, los-
ing its purulent character, and gradually decreasing in
amount."

The odor and taste of ichthyol have for the past twenty
years prevented many consumptives from having the advan-
tages of this remedy. Prescribed in aqueous solution it is
foul tasting and odorous, very often nauseating to a degree
to produce vomiting. The very large dose, which sometimes
becomes necessary to obtain its benefits, has added to these
disagreeable features. Given in capsule the odor and taste
have not always been eliminated ; also some patients have
found it very disagreeable or impossible to swallow the cap-
sule, due however to a neurotic cause, yet nevertheless exist-
ent. It was also difficult to get the patients to take enough
water with each dose to make a dilute solution in the stom-
ach, so as to prevent irritation, with consequent eructation cr
"rifting." Since the gelatin-coated pill often passes out with
the stool, being undissolved in the stomach or bowel, the
therapeutic action of ichthyol in this form can not be de-
pended upon.

For the past several months I have been using ichthyol in
the form of ichthyolated emulsion comp. It contains ich-
thj'ol, grs. 10 ; apinol, min. 10 ; ol. sassafras, min. 5 ; ol.
olivae, ol. gossypii seminis, glycerinum and mucil; acacia,
qs., oz. 1. The odor and taste of the ichthyol are disguised.
The apinol incorporated, which has all of the physiological
actions of creosote with much less tendency to irritation, en-
hances the action of the ichthyol and eliminates the necessity
of such large doses.

I find that this emulsion gives all the physiological effects

442 FIFTY-FIFTH ANNUAL SESSION

of ichthyol and creosote. That it is well borne by the stom-
ach and bowel, has a tendency to overcome constipation, is al-
most a specific for indicanuria. I give it in a glass of cold
milk six times daily, beginning with a teaspoonful at a dose,
slowly increasing until the j)atient is taking a tablespoonful
at each dose.

I have seven cases which I have treated with this emulsion
I wish to report in a general way. Four of them were first-
stage cases, all having slight fever and accelerated pulse.
Three of these cases were complicated with a tendency to con-
stipation. The average length of time treated was nine
weeks, and the average gain in flesh was nineteen pounds.
The highest gain was twenty-six pounds, the lowest was twelve
pounds. All were having a normal pulse and temperature,
and the cough and expectoration had disappeared at the ex-
piration of treatment. There seemed to be an arrest or cure
of the disease in each instance.

There was one second-stage case ; a rather large woman,
weighing 144 pounds when beginning treatment. Her tem-
perature was 101.5 ; pulse 114. After eleven weeks treat-
ment she had gained twenty-three pounds, the temperature
and pulse being normal, and the cough and expectoration had
almost entirely ceased. She stopped treatment and has been
lost sight of. She gave promise of making a complete arrest
or cure of the disease.

The remaining two cases were third-stage cases, one com-
plicated with tubercular laryngitis the other with tubercular
enteritis. Both had both upper lobes involved, and were hav-
ing high temperature and rapid pulse. The case complicated
with tubercular laryngitis was treated for fourteen weeks with
considerable improvement in the lung condition, no change
in the larynx, with prompt reduction in temperature and
slower heart action, gained much in strengih and added eight
pounds in weight. He stopped treatment, went home, and
has since grown worse. The other third-stage case, compli-
cated with tubercular enteritis, made a far greater improve-

N. C. MEDICAL SOCIETY.

443

ment. The bowel condition was apparently arrested by the
use of magnesium sulphate in five grain doses every two hours
for three weeks. The lung condition greatly cleared, becom-
ing quiescent, and the patient gained twenty-eight pounds in
seventeen weeks. Her temperature and pulse reached the
normal. She went home, from where she reports she is doing
as well as when she left my care.

I employed in all these cases the usual hygienic and diet-
etic treatment, and with the two third-stage cases and one
of the first-stage cases I employed tuberculin. While I have
used" ichthyol- in capsules in my practice in a large number of
cases the results I have obtained with ichthyol in the form
of an emulsion have been far superior. While ichthyolatod
emulsion compound has not produced these good results un-
aided, yet I feel and believe that it has been a most valuable
adjunct.

REFERENCES.

1 Mat. Med., Pharm. and Ther., 1899, p. 488.

2 Mat. Med. and Ther., 1899, p. 349.
sinter. Med. Annual, 1898, p. 417.

4 La France Med., Nov. 12, 1897.

5 Med. News, Vol. LXXIII, p. 144.

6 Med. Rec, Vol. LV, p. 730.

7 Charlotte Med. .Jour., Vol. XIII, p. 17.

444: FIFTY-FIFTH ANNUAL SESSION

THE TURK OF THE TIDE OF TUBERCULOSIS
MORTALITY.

BY MABTIN L. STEVENS, M.D., ASHEVILLE, N. C

Tuberculosis is still the most formidable disease, notwith-
standing the fact that it is a preventable one. The knowledge
of the means of its prevention is onlj recently being dissemi-
nated.

N^ever in the history of medicine have so many scientific
men been devoting their best energies to the prevention of
any disease, and never have governments and private indi-
viduals alike been so united in the determination to stamp
out any malady.

Already fruits are being borne. In the last decade the
United States and all the European countries except one
show a lower mortality from it than in the previous ten years.
The tide of mortality has already begim to ebb, and we can
now feel the positive assurance of the continued lowering of
this mortality from year to year.

The factors most potent for good in this cause are :

1. The educational crusades now being carried on by the
International and National Associations for the prevention of
tuberculosis through the medical journals for the physicians,
through the magazines for the literary public, through the
newspapers for the business people, and by public lectures,
posters and tracts.

2. The sanatoriums, the patients of which become educators
in their home communities.

3. The State and local Associations like our own which
are supplementing the work of the larger bodies.

4. The tuberculosis exhibits which in the Southern States
alone have been visited by 150,000 people since the James-
town Exposition.

5. By the teaching of the prevention of tuberculosis in the

N. C. MEDICAL SOCIETY. 445

public schools, which will ultimately be done in all the States
and which our own ''Old i^orth State" was the first to begin.
A class of responsible persons who have been more or less
tardy in assuming the full burden of their responsibility in
this cause is our own medical profession. True, the medical
school from which we graduated sadly neglected this branch
of medical education, and the post-graduate schools of to-day
are equally derelict in this part of the work; but after Sep-
tember and October this excuse will no longer hold good, for
at that time the International Congress of Tuberculosis will,
during its three weeks session at Washington, offer a j^ost-
graduate course in the prevention of this disease such as has
never before been offered and of which the world's best special-
ists will be the instructors. A disease which carries off one-
fourth of all those who die between the ages of fifteen and
thirty-five is surely deserving of the most careful study on
the part of every j)ractitiouer, and I trust that every member
of our State Association will enroll his name as a member of
this International Congress. "When we can get the medical
profession to realize fully its responsibility and opportunity
in this matter one of the greatest wonders of preventive med-
icine Avill have been accomplished, and tuberculosis will then
soon be as much a thing of the past as is leprosy at present.

446 FIFTY-FIFTH ANNUAL SESSION

TUBERCULIN THERAPY.

BY C. S. GRAYSON, M.D.. HIGH POINT, N. C.

Mr. President and Members of the North Carolina Medi-
cal Society: It is an established fact that one-seventh of all
deaths are caused by tuberculosis. It has been estimated that
nine-tenths of all persons living in this country contract the
disease at some time in one or more of its various forms.

To digress, if we consider the matter from a purely scien-
tific standpoint, we are forced to admit that at the present day
the tubercle bacillus is the greatest factor in nature's great
improvement scheme, "The survival of the fittest." Tubercu-
losis is a disease from Avhich the strong are immune or re-
cover and from which the weak die. A vigorous man, even
when he has contracted the disease in a severe form, will re-
cover if given at all favorable conditions. They do not con-
tract it unless temporarily debilitated or exposed to excessive
numbers of the bacilli.

It is quite certain that the persons saved by eradicating the
bacilli would be weaklings. Many of them would be saved
for lives of suffering and for the propagation of a still weaker
offspring. We must remember that most of those we would
save by eradicating the germ of tuberculosis would be saved
for a more lingering and painful death by other diseases.

The tubercular patient is notably cheerful and hopeful. It
seems that God created the tubercle bacillus for a sifter of
His creatures, to sort out and destroy those whose low vitality
w^ould render life to them more painful than pleasurable and
whose offspring would still further weaken the race. Were
it not for the decided analgesic and pleasurable effects of
tuberculosis these weaklings would be condemned to a life
of toil, dyspepsia, chronic catarrhs of the stomach and intes-
tines and a host of other painful and melancholic diseases that
have no germ with analgesic properties. Physicians in their

N. C. MEDICAL SOCIETY. 447

desire to save life sometimes forget that death is not the worst
evil that may befall a man. Some have gone so far as to say
that physicians busy themselves propping up the v^^eak, and
for that reason are brakes on the v/heels of the Almighty.

When these armies of tubercle bacilli invade the tissues of
an individual all avenues by which they can be attacked are
closed save that one whose gates are good food and God's free
air and sunshine; and by these measures, from a scientiiic
point of view, every one is saved that is Avorth the saving.

The tuberculin treatment is a vaccine treatment. In tuber-
culosis pure and simple there is no toxaemia, and therefore
tuberculin has no place in the treatment of this? disease. To
substantiate the above statement we find that the world estab-
lishes immunity to widespread diseases in which there is a
toxaemia. In the early centuries smallpox almost depopulated
some countries of the old world. By the use of Jenner's vac-
cine and by the prevalence of the disease the world is now
immune to such a degree that it is difficult to make a positive
diagnosis. The natives of Africa by constant exposure have
become immune to the poison produced by malaria. The Eng-
lish and German immigrants, not immune by exposure to this
deadly form of malaria, are overwhelmed by the poison and
die by the score of black-water fever. Influenza, at one time
quite a serious disease, is now of little consequence. The In-
dian, living in the forest, exposed to snake venom for cen-
turies, has become so immune that he suffers little more than
a simple inconvenience from the bite of the rattlesnake.
Colics in his law states that a nonsyphilitic woman who has
borne a syphilitic child is herself immune, and can not be
infected though she nurse the child.

iSTowhere in the study of tuberculosis have we evidences of
immunity similar to those just enumerated. Were the tu-
bercle bacillus a toxin-producing organism immunity to those
toxins would have been established. On the other hand, leav-
ing out the recent decrease brought abaut by the open-air
treatment and better supervision of the general health, tuber-
culosis has become more prevalent every year.

448 EIFTY-PIFTH ANNUAL SESSION

A tubercular lesion of the skin is termed a lupus. It may
make its appearance about the lip, and finally destroy it and
the neighboring ala nasi. Pulmonary tuberculosis is simply
a lupus of the lung. The tubercle bacilli sloAvly destroy the
lung tissue. This process of destruction goes on until the
patient dies for want of sufficient lung tissue to aerate the
blood.

The inflammatory processes are greatly favored by the con-
stant respiratory movement. A fractured limb heals more
readily when immobilized. Fixation favors healing in pul-
monary tuberculosis. It has been found that when tubercular
patients are kept at rest in pure open air, where the number
and depth of respiratory movements are reduced to a mini-
mum, cures are much more readily effected. For that reason
active exercise so warmly recommended by the older physi-
cians has been abandoned. It is the local condition and not a
toxaemia that requires attention, and the day may come when
if but one lung is affected the corresponding side will be
strapped and kept at rest as in pleurisy, until the lesion is
healed.

The symptoms of an uncomplicated case of tuberculosis
are insignificant and indefinite. You can not conceive of a
condition where there are bacilli-secreting toxins without ap-
preciable symptoms. The symptoms are due to mixed infec-
tion and to loss of tissue, and not to a toxemia. Here are the
symptoms of a certain condition copied from Osier. Diag-
nose the case in your own minds. "There is an elevation of
temperature, it is irregular in type, sometimes there is a chill,
and the temperature may rise to 103 or higher. Owing to the
intermittent character of the fever the disease is often mis-
taken for malaria. Fever may rise in the afternoon without a
chill. Profuse sweating is common, particularly when the
patient falls asleep." These are symptoms of abscess of the
liver and we conclude that similar symptoms in tuberculosis
are due to the presence of pus cocci. Osier says that sup-
purative processes play an important part in pulmonary tu-

N. C. MEDICAL SOCIETY. 449

berciilosis, many of the symptoms of ^vhich are due to them.
Languor and lassitude result from faulty aeration of the
blood. The same results are produced by breathing the air
of a poorly ventilated room. In tetanus the toxaemia is pro-
nounced and the ante-mortem temperature may reach 110.
Even in acute miliary tuberculosis the temperature rarely
goes above 103. The toxins of typhoid produce delirium and
unconsciousness, while in tuberculosis the mind is practically
always clear.

The toxins of diphtheria, scarletina and a number of other
diseases excreted by the kidneys produce nephritis. In tuber-
culosis such a long continued irritatioii would produce a
nephritis, yet there is none. Toxins have been isolated from
tetanus and diphtheria cultures, but nowhere do we read of
the isolation of a toxin from the growth of tubercle bacilli.

Behriug immunized animals against tetanus and prepared
an antitoxin that would protect animals suffering from that
disease. In diphtheria we have to deal with a toxaemia, and
to prove this conclusively an antitoxin has been prepared by
immunizing animals. With reference to this in tuberculosis,
Baldwin, of Saranac Lake, says : "Antitoxic serums have
met with little success. Trudeau and Baldwin could obtain
no evidence of any antitoxic properties in the serum of the
horse, cow, chicken or rabbit treated with tuberculin."

We might learn a lesson by observing nature's method of
curing tuberculosis. jSTature treats the tubercle bacillus as
a foreign body and not as a toxin-producing organism. A
bullet lodged in the tissues is encysted and gives no further
trouble. Xature attempts to encapsulate the tubercle bacilli
and in the strong, succeeds. While the bullet is being en-
cysted, though the wound be aseptic, there is slight fever and
leucocytosis just as we obsei*ve in tuberculosis during the pro-
cess of encapsulation.

As to the merits of tuberculin let me quote a few leading
physicians. Abbott, Professor Bacteriology, University of

450 FIFTY-FIFTH ANNUAL SESSION

Pennsylvania: "As a curative agent for tuberculosis, tuber-
culin has not merited the confidence that was at first accorded
to it. Its field of usefulness is now almost limited to the
diagnosis of obscure cases, and for this purpose it is less fre-
quently employed than formerly."

Stevens, Professor Physical Diagnosis, University of Penn-
sylvania: "Tuberculin is now rarely used as a therapeutic
agent, although it is still retained for diagnostic purposes."

Osier : "The use of tuberculin has been in great part aban-
doned, but recently Koch, Behring and others have again
called attention to its possible value."

Shoemaker, Professor Materia Medica and Therapeutics,
Medico-Chirurgical College : "Experience has amply demon-
strated that, as a curative agent, tuberculin is valueless."

Jenner's vaccine is used to immunize the well, thus pre-
venting the develoj)ment of smallpox. Who would withhold
the vaccine until smallpox develops, then inject it in an effort
to raise the patient's opsonic index ? If it has virtues why
is tuberculin not used to prevent the development of tuber-
culosis ?

Special attention is called to the class of patients for which
tuberculin is recommended. Baldwin says: "Tuberculin
should be administered to patients who are afebrile and in a
state of good nutrition. It is also indicated in early closed
pulmonary tuberculosis. In patients whose temperature
reaches 101, too much must not be expected from tuberculin.
It is rarely wise to administer tuberculin to patients whose
minimum temperature does not fall below 99 every day. It
should never be given to patients suffering from acute coryza,
gastric disorders, fatigue or is feeling 'out of sorts' from any
cause."

Koch says: "The application of tuberculin should be re-
stricted to those cases not too far advanced and not compli-
cated by the streptococcus, staphylococcus, pneumococcus and
influenza bacillus, since those processes are almost always ac-
companied by an elevation of temperature. The best way

N. C. MEDICAL SOCIETY. 451

to guard against the misapplication of tuberculin is to admin-
ister it in no case where the temperature exceeds 98.6. The
hygienic and dietetic treatment should be faithfully followed
throughout this treatment."

Note, too, the time required to effect cures by this treat-
ment. Baldwin says : ''It is futile to expect any course of
tuberculin treatment extending over two or three months to
be of any permanent value. No patient should be given
tuberculin who can not follow the treatment for at least five
months."

Trudeau says : "I am convinced that this treatment should
be extended over a long time. Time is an important element
in obtaining the best results. Six months is almost always
necessary and a year or more would be better in many cases."

To summarize, tuberculosis is itself nontoxic: (1) Because
no toxin can be isolated. (2) No world-wide immunity is
produced by its prevalence. (3) Because no immunity can
be induced in animals. (4) Because the symptoms are riot
pronounced as in other toxeemias. (5) Because all the symp-
toms can be otherwise accounted for. (6) Because tuber-
culin will not prevent those in good health from contracting
the disease.

The tuberculin treatment is a failure: (1) Because a vac-
cine treatment is useless in a nontoxic disease. (2) Because
it can be used only in the mildest cases. (3) Because it fails
in these cases without the hygienic and dietetic measures
which effect cures without it. (4) Because the same time is
required to effect a cure that is required without it.

We conclude, therefore, that infinitely more of these mild
cases recover every year without any treatment than tubercu-
lin has ever cured, or, in my opinion, ever vdll.

452 FIFTY-FIFTH ANNUAL SESSION

EARLY TUBERCULOSIS AND MALARIA; THEIR
DIFFERENTIATION.

BY PAUL H. KINGER, A.B., M.D., ASUBVILLE, N. C.

Cases of incipient pulmonary tuberculosis particularly in
individuals coming from malarial districts are so often diag-
nosed as malaria and proper hygiene and diet not resorted to,
that a few words on the differentiation of these two diseases
may not be amiss.

The differential diagnosis is at times difficult — usuall;y,
however, it is quite possible if the case be studied carefully.
Let it be understood at the start that reference is not made to
pernicious malaria — to malarial cachexia — but to tertian,
quartan and sestivo-autumnal malaria as opposed to first-
stage pulmonary tuberculosis.

The diagnosis may be considered under three distinct head-
ings:

I. Clinical Symptoms.
II. Laboratory Findings.

III. Therapeutic Test.

Clinical Symptoms.

Chills. — In both diseases we may have actual chills or chilly
sensations, but a definite rigor speaks far more in favor of
malaria than of tuberculosis — cases of the latter disease hav-
ing marked chills are usually so far advanced that a correct
diagnosis forces itself.

Fever. — A common symptom of both diseases, usually
higher in malaria than in early tuberculosis, and rising sud-
denly in malaria as compared with a gradual ascent in tuber-
culosis. The fever of malaria comes on with a rush — the
patient is seized with a chill and in twenty minutes has a
temperature of from 101 to 104. A very typical temperature-
curve of incipient pulmonary tuberculosis, taken from the
record-book of one of my patients, is the following :

N. C. MEDICAL SOCIETY. 453

11 a. m., 98.8 ; 1 p. m., 99.5 ; 3 p. m., 100 ; 5 p. m., 100.6 ;
7 p. m., 99.8.

A carefully kept two-hourly temperature record is oue of
the best means of differentiating the two diseases.

In malaria fever usually drops by crisis — in tuberculosis,
by lysis — however, in the sestivo-autumnal type of malaria,
fever may last more than twenty hours (this not occurring in
early tuberculosis) and fall by lysis. The fever in this type
of malaria may even be continuous. The picture then being
suggestive of typhoid fever rather than tuberculosis.

Sweat. — Far more profuse in malaria than in early tuber-
culosis where real sweats are uncommon. Drenching sweats
occur only in the more advanced cases of tuberculosis ; in ma-
laria they may occur after every paroxysm of fever.

General Feelings. — A most important point in my opinion
is the fact that between paroxysms, the malarial patient feels
well — the tuberculous patient feels sick. The malarial pa-
tient (unless he be the victim of an old chronic malarial pois-
oning) recovers swiftly from his paroxysm. The tubercu-
lous individual is constantly a prey to the tuberculo-taxius,
and consequently feels w'eak and below par all the time.

Bronchitis. — May be a symptom in both diseases — in ma-
laria is usually diffuse and at the base of the lungs poste-
riorly— in early tuberculosis often sharply localized and at
an apex.

Breath Sounds. — These are of paramount importance, par-
ticularly in the apical region. Rough breathing has been w-ell
pointed out by Grancher to be the first detectable physical
sig-n of pulmonary tuberculosis. With an afternoon fever,
whether preceded by a feeling of chilliness and followed by a
sweat or not, if at one apex the breathing is roughened as
compared with that at the opposite apex, whether expiration
be prolonged or not, a diagnosis of incipient pulmonary tu-
berculosis is so probable as to be justifiable. Dullness and
rales need not be awaited. They set in when the tubercles
have coalesced and when bronchitis has set in, rough breath-

454 FIFTY-FIFTH ANNUAL SESSION

inff denotes discreet tubercles. Careful auscultation above
the clavicles and particularly in the first intercostal space
close to the sternum is a sine qua non for the earliest possible
diagnosis of pulmonary tuberculosis.

Splenic Enlargement. — Usually present at some time in
malaria — not present in tuberculosis.

Herpes Labialis. — Not seen in early tuberculosis; accord-
ing to Osier, it is almost as frequent in malaria as in acute
lobar pneumonia.

Laboratoky Findings.

The blood and sputum should be carefully, and (if nega-
tive) repeatedly examined in making this differential diag-
nosis. I again say "repeatedly," for one negative examina-
tion, whether for malarial plasmodia or tubercle bacilli, is
worth nothing. Furthermore, the plasmodia are often found,
but at certain times, preferably during the height of the
fever. ISTot long since in the private laboratory of Dr.
Charles L. Minor, of Asheville, I examined the blood of a
patient taken while having a chill in the office. No plas-
modia were demonstrable. Half an hour later, the patient
being in the febrile stage, more blood was examined, and in
almost every field of the microscope two or more plasmodia
were found. The stain I prefer is the ordinary Jcnner, on
account of its rapidity and simplicity. When possible, the
fresh unstained blood should be examined as w^ell as stained
specimens. In examining for tubercle bacilli, morning spu-
tum should be chosen and the thickest bits selected. Much
of the success in finding tubercle bacilli depends upon perfect
technique, which can not be entered into here, but with
proper smearing and staining methods they should be demon-
strable if present at all.

We can assert that if blood and sputum be carefully and
repeatedly examined for plasmodia and bacilli — if all exami-
nations be negative, — if there be ever so slight a change in
the breath sounds at one apex — if intermittent fever and
general malaise persist, the case is one of tuberculosis and
not of malaria.

jsr. c. medical society. 455

Therapeutic Test.

Osier has given us an axiom : "i\.n intermittent fever that
resists quinine is not malarial." Therefore, if need be, let
quinine be exhibited; if the patient recover, malaria was
present ; if n )t, malaria can be ex eluded.

Stress should be laid upon the fact, particularly in ma-
larial districts, that tuberculosis may set in with fever typi-
cally intermittent in character — daily chill, with subsequent
fever and sweat — but careful note of the points mentioned
should clear up the etiology of the febrile movement.

The importance of a correct diagnosis between these two
conditions is more than apparent. Yearly scores of people
are sent to Asheville from all parts of the country to rid their
systems of malaria, when in point of fact the tubercle bacillus
is the prime factor. We do not deny that the two diseases
can and do coexist; but we do urge that the most important
diagnosis is that of tuberculosis. In this country malaria
seldom kills; tuberculosis is our greatest scourge. Quinine
in proper doses will shortly arrest malaria — months of rest,
fresh air, good food, a minutely regulated life, are essentials
to the cure of tuberculosis. Malaria is not communicable
save through an intermediate host — every careless or ignorant
tuberculosis patient, expectorating broadcast, is a serious and
dangerous menace to his family and to his community. Let
us, therefore, take these facts to heart, and, even though resid-
ing in a malarial district, when a patient presents himself
with symptoms suggesting paludism, kt us well consider the
pros and cons, and exhaust all our scientific knowledge in an
earnest effort to discover positively whether we have to deal
with the Plasmodium malariiP, or with the bacillus of tuber-
culosis.

456 FIFTY-FIFTH ANNUAL SESSION

SOME ATYPICAL MAISTIFESTATIOE'S OF
MALARIA.

BY J. W. P. SMITHWICK, M.D., LaGRANGE, N. C.

To begin, it may be safely stated that all pernicious and
atypical forms of malaria are caused by the sestivo-autumnal
(ha^matazoon falciparimi) variety of the malarial Plasmo-
dium. I have found no case, either on record or in my prac-
tice, which will justify any other statement.

The pernicious forms of malaria are usually confined to the
tropical regions in which malaria occurs and, therefore, are
not observed by l^orth American practitioners. Malarial
hjEmogiobinuria, on the other hand, is seen commonly occur-
ing in some sections of our country during the fall months,
but as its diagnosis and management are fairly well established
I shall confine this study to the consideration of those mani-
festations which do not resemble malaria as ordinarily seen,
but which are due to the presence of the aBstivo-autumnal para-
site, and which present such symptoms of other diseases as
to be easily confounded with or mistaken for them. No at-
tempt at classification will be made, but each form, as I have
observed it, will be taken for consideration as seems best.

Hemorrhagic Nephritis. — I use this term for those eases
in which there is but little, if any, febrile disturbance, and in
which occurs a true hemorrhage from the kidneys. This con-
dition, directly depending on malarial infection, where the
blood and urine have been examined with positive findings,
has been noted by a number of observers, and there is no
doubt that it occurs although some have attributed its occur-
rence to the administration of quinine. Baker (Johns Hop-
kins Hospital Reports) observed a case of this condition, and
in 616 cases of malaria studied by Thayer and Ilewetson
{Johns Hopkins Hospital Reports) occurring in Baltimore,
it was noted once only. Pace {Gior. Internaz. de Sc. Med.
Napoli) reports a cnso in which the U'Stivo-autumnal organ-

N. C. MEDICAL SOCIETY. 457

isms were found in the blood, with no other symptoms of ma-
laria except a true hemorrhage from the kidneys. I have seen
two or three such cases. All showed the sestivo-autumnal
parasite in the blood and urine, and all had a true hemorrhage
from the kidneys. The following case is a good illustration:

Mrs. D, . . ; widow; aged 26 years. Had sustained irregu-
lar attacks of intermittent tertian malaria several years pre-
vious, but lately had lived on the seacoast, where she had been
healthy. She changed her residence to a small town about a
hundred miles inland. A few months after this changs of
residence she noticed a reddish cast of her urine, but, feeling
about as well as usual, paid no attention to it. Some weeks
later she did not feel well and noticed a slight rise of tem-
perature each afternoon. Also about this time the color of
her urine deepened considerably; all of which caused her to
seek medical advice. When I saw her she was anaemic, lips
pale, temperature 99.5 deg. F., spleen enlarged and tender
on pressure, and her general appearance was one of chronic
paludal poisoning. Microscopic examination of urine demon-
strated a true hemorrhage from the kidneys. The urine was
acid in reaction, smoky in appearance, and contained round
blood cells, blood and hyaline casts. The malarial parasites
could not be detected in the urine at that time, but they were
readily found in the blood — the small concentric form. The
following day I made another microscopical examination of
the urine and succeeded in finding a few of the parasites.
Under systematic anti-malarial treatment the patient im-
proved rapidly, the parasites disappearing from the blood,
and the blood and albumin from the urine.

The facts presented in this case are: (1) There was a
true hemorrhagic nephritis; (2) it was undoubtedly due to
malarial infection of the'?estivo-autumnal form, as the para-
sites were found in both the blood and urine; and (3) com-
plete recovery resulted upon antimalarial treatment.

Diseases of the Heart. — Law (British Guiana Med. Ann.)
is of the opinion that definite heart disease occurs due to

458 FIFTY-FIFTH ANNUAL SESSION

malaria where the patients have lived in a malarious country,
Moscato (Morgani, Milano) relates the case of a man who
had had neither rheumatism, nor any infectious disease like
typhoid fever, nor erysipelas, and who had not abused alcohol,
tea or tobacco. Five months of the j)revious year before the
time he was seen by that author he had malaria, but when
Moscato examined him he showed symptoms of mitral insuffi-
ciency. The heart was hypertrophied, albumin was in his
urine and his body was ojdomatous, and his spleen was en-
larged. Renzier (Bev. de Med. Paris) finds functional mur-
murs frequently associated with malarial poisoning.

Functional murmurs associated with malaria are often
observed. These are dependent upon the anaemia and gen-
eral muscular weakness which are always coincident with
malaria. They are purely functional, and in my experience
always disappear upon the full recovery of the patient. How-
ever, it seems that organic disease of the heart as pointed out
by Moscato does occur, and the following would appear to be
such a case:

William R. . . . consulted me in 1898. Gave a history of
recurring attacks of intermittent malarial fever until about
two years previous, since which time he had been doing fairly
well. There was no history of rheumatism or infectious dis-
ease. Family history was negative. He was a lad of eighteen
years ; not well nourished, and sallow and cachetic in appear-
ance. Pulse was full, a little rapid, about eighty to the miii
ute, and irregular. There was considerable hypertrophy of
the heart and a mitral murmur was present. The beat of the
heart was labored, and at times there was a slight dyspnoea
when the patient was quiet. Spleen and liver were enlarged,
but urine contained no albumin. Patient stated that he had
been troubled with ''fever cake" for quite a while. Careful
and repeated examinations of the blood revealed a few concen-
tric malarial parasites. A later examination showed both
the concentric and flagellated forms of the sestivo-autumnal
variety. Repeated examinations of the blood also showed the

N. C. MEDICAL SOCIETY. 459

parasites to be more numerous at times than others. This
patient was put on full doses of quinine sulphate and capsi-
cum and strong tonics, with the result of improvement from
the beginning. After three weeks treatment no malarial
micro-organisms could be detected in the blood. After this
antimalarial tonics were administered for four successive
months, and at the end of that time there was so much im-
provement that the patient declared himself to be as well as
he ever was. There was some hypertrophy and a slight mur-
mur of the heart, but these have not increased since he was
dismissed, and to all appearances now he is well.

In this case there was no elevation of temperature at any
time that I saw him ; the £estivo-autumnal form of malarial
parasite was easily demonstrated; the spleen and liver were
enlarged; the heart was considerably hypertrophied, and
there was a mitral murmur. Quinine and anti-malarial tonics
effected a cure to all intents and purposes. There was an ab-
solute disappearance of all symptoms and signs except a slight
heart murmur and hypertrophy. It is my opinion that at
some later date his valvular trouble will increase and become
troublesome, as it would if dependent upon some other usual
etiologic factor. I believe all the trouble in this case was
wholly dependent upon the malarial infection, and that it was
proven by the microscope and treatment.

Malarial Orchitis. — Charcot (Eev. de Chirg. Paris), Coro-
vado (C/iroK. Med. Quir. de la Hah ana), Snldifie (India Med.
Jour.), and Lardier (Bull. Med. de Vosges) all report cases
of orchitis due to malarial infection. In some of these cases
the orchitis occurred during the malarial attack, but in most
of them it occurred after pronounced attacks of malaria.

I have seen only one person who had an attack of orchitis
which I deemed to be due to malarial infection. The history
of the case in question was this: Patient forty-two years of
age; married. Had been well for some time previous with
the exception of a sallow complexion. He was taken with
severe pain in right testicle, followed by considerable swell-

460 FIFTY-FIFTH ANNUAL SESSION

ing. I saw him about two hours after the beginning of the
attack. He had a temperature of 102.5 deg. F. ; considerable
pain in testicle, which was swollen to about three times its
normal size. There was no history of injury nor recent gonor-
rhoeal infection. I administe^d morphine hypodermically
and he was soon quiet. Ordered tobacco poultices to be ap-
plied to the affected part, and left a dose of calomel to bs
taken at bed tiine. About the same hour the next day I was
again called. I found him suffering severe pain and a much
swollen condition of the testicle ; temperature elevated as on
the previous day. This phenomenon caused me to suspect
some periodical etiologic factor and, accordingly, I took a
blood smear for microscopical examination. This revealed a
good number of malarial plasmodia of concentric form. I
put the patient on full doses of quinine, and all the symptoms
rapidly disappeared. This case was, beyond all doubt in my
mind, due to malarial infection, as there was nothing else to
which it could be attributed. The plasmodia were present in
the blood and a complete and rapid recovery resulted upon
the administration of quinine.

Malarial Anasarca. — In many cases of malaria in which
the infection has existed for a long time it is not at all un-
common to have some oedema, but general anasarca is not
common. Pope (American Prac. and Neivs) says anasarca
is common in chronic cases of malaria. Norton (Jour. Am.
Med. Sciences) mentions three cases that occurred in the Em-
ergency Hospital, Washington, D. C. In these cases there
was marked oedema of the legs following attacks of malaria.
The blood of the patients showed many crescents (sestivo-
autumnal malaria). These patients recovered when put on
quinine regularly. The urine in these cases was negative.

Two cases I have seen will be interesting. The first was
that of a boy seventeen years of age. Parents had always
lived in malarious section and various members of the family
had suffered repeated attacks of malaria. This boy's feet
and ankles beffan to swell about six months before I saw him.

N. C. MEDICAL SOCIETY. 461

Three months previous to that he had an attack of tertian
malarial fever, from which he seemed to fully recover. Two
or three weeks later he noticed a swelling of ankles upou re-
moval of shoes at night. After this he had no more malarial
paroxysms, was not inconvenienced by urine at any time,
though it was reddish at irregular intervals. When I saw him
he had the appearance of one suffering from Bright's dis-
ease. Tie was anaemic and there was oedema of nearly all por-
tions of the body, being much marked in legs. There was
considerable puffiness iibout the eyes and face, and the skin
was of a pasty appearance. Pulse was accelerated though
there was no elevation of temperature. Examination of urine
was negative. He complained of aching sensation in bones,
and there was slight dyspnoea at times. Was not nauseated,
though ajDpetite was very poor and spleen and liver were con-
siderably enlarged. Microscopic examination of the blood
showed large numbers of crescents and pre-flaggelating forms
of malarial organisms. All these symptoms disappeared, and
the boy fully recovered on full doses of quinine and tonic
doses of Fowler's solution of arsenic. The other case was
similar to the above. It occurred in a man fifty-three years
of age, and I was led to believe the trouble to be Bright's dis-
ease and treated it as such a few weeks. His urine showed
a slight amount of albumin at times, oedema was marked and
dyspnoea troubled considerably by spells. His improvement
was none, and I happened to think to make examination of
blood for malarial plasmodia and found them, both the con-
centric and flaggclated. I put him on quinine and Fowler's
solution and he made a rapid and uneventful recovery.

462 FIFTY-FIFTH ANNUAL SESSION

THE TEEATMENT OF TYPHOID FEVER.

BY T. C. QUICKEL, M.D., STANLEY, N. C.

That we have no specific treatment for this formidable
disease nor agent that will weaken the organism that causes
it remains a fact that we all deplore, but which none of us
have as yet been able to modify. We are still limited in our
efforts to the guiding and guarding of our patient so that he
may offer the utmost resistance and strongest defense of which
his body is capable. I would have you regard your patient
as a human battlefield, a region invaded by a strong and mul-
titudinous enemy, and the cells of his body constitute the de-
fensive forces. You are to be the commanding general of
these cellular warriors fighting for the very existence of the
body of which they are the microscopical units. It is our duty
to see that these legions are kept in the very highest fighting
condition that is in our power by the means at our disposal,
and that no obstacle that can be removed is allowed to re-
main to hinder them in this struggle. We must see that they
are properly nourished, secure as much rest as possible, and,
above all, that no extra work that is not absolutely necessary
is placed upon any of its specially organized groups. It is
early in the attack that your services are most needed. The
organs must be strengthened, and the overworked ones re-
lieved. I believe that it is during the first and second weeks,
the time before the decisive conflict, that the result is most
often determined. If during this time we have provided a
suitable nourishment, secured a reasonable amount of quiet
rest, and have been able to control the diarrhoea and tympan-
ites, the final victory will usually be satisfactory. But if
we have been negligent or unsuccessful in our efforts the ill
consequences will be all the more apparent when we come
down to the turning point in the contest.

n. c. medical society. 463

Diet.
To find a suitable diet for these patients I often find diffi-
cult. Sweet milk, when considered by the physiological
chemist, is doubtless the ideal food. But in my experience
I have found it unsuited to the digestion of many typhoid
patients, forming hard, indigestible curds and aggravating
the diarrhoea and tympanites. Buttermilk is often taken with
relish and when it can be used is a splendid nourishment.
Eggs, well-beaten, flavored and taken raw or the whites may
be slightly coagulated, sometimes serves as suitable food dur-
ing this illness. I might mention other articles of diet suit-
able for these patients, and doubtless some of you can make
helpful suggestions. But it is no one diet that will suit all
or even a majority of these patients, and I desire to urge you
to study carefully the digestive ability and individuality of
each digestive tract and so modify your diet that it will be
digested and assimilated. If you can not secure a diet that
will be digested and used it is preferable to withhold all food,
because this decomposing and fermenting contents in the ali-
mentary tract will still further irritate the inflamed bowel
and add more poison to an already poisoned system, and thus
decrease his strength rather than sustain it. The too fre-
quent feeding must also be avoided. Every five or six hours
is often enough to feed a sick stomach, and if the diet is suit-
able, enough can be taken at each feeding to satisfy the de-
mands of these patients.

Best.

It is of great importance that we secure for our patients
as much rest as possible. To keep them in bed and thus se-
cure bodily rest, is after the first few days little trouble, for
they do not, as a rule, feel like fitting up. To secure the
much-needed mental quiet and rest is often more difficult,
especially during the first week. Their business cares and
daily duties are not so easily laid aside at our direction, but
fortunately, they are soon forgotten by most patients. How-
ever, there is one source of annovance and a disturbance of

464 FIFTY-FIFTH ANNUAL SESSION

their mental quiet which we can and must eliminate from the
very beginning. I have reference to the presence of visitors
in the sick room, with all their solicitous inquiries, wise sug-
gestions, and disturbing gossip. This you may find hard to
do if you serve a rural district such as I do, where we are
dependent upon the family for the care of the sick member.
But you owe it to your patient and yourself to see that your
directions in this matter are observed. By so doing you will
eliminate one of the potent causes which exaggerates the ner-
vous excitement usually present during this illness.

Medicines.

In an uncomplicated attack, there is no indication for any
extensive use of medicines. But I am an advocate of the
beneficial influence of intestinal antiseptic agents. ISTot that
I hope to destroy any of the typhoid baccilli by their use,
and it is not for this purpose that I employ them, but to hin-
der the fermentation and decomposition of the residual food
and secretions of the bowel. That we can prevent to some
extent these changes is apparent to me in my work, and does
not seem impossible wdien we consider the small quantity of
preservative agents that is required to prevent these changes
in milk, meat and fruits outside of the body. I use salol for
this purpose. In addition to this the old and time-tried tur-
pentine emulsion to which .1 add tincture iodine, is the treat-
ment I most often employ. Additional medicines must be
determined by special indications as they arise. When we
need stimulants strychnine and cafteine are most often indi-
cated. Alcohol is very rarely indicated in my work, and I
consider it harmful to the majority of the patients. Its par-
alyzing effect on the sympathetic nervous system and tendency
to irritate the stomach should make it a rarely used agent
in this disease. My only use for it in typhoid fever is in
case of depression where a rapidly acting agent is required,
and not for continued administration.

The use of large doses of quinine early in the attack as a

N. C. MEDICAL SOCIETY. 465

means of diagnosis should rarely be necessary, and its injuri-
ous effect may be evident during the remainder of ths illness.
Ringing in the ears, nervous tremors and sometimes delirium
owe their presence in part to the energetic administration oi
this remedy. Opium is another agent, while it is indispen-
sable in certain complications, should be limited in its use to
these alone. It should not be used to produce sleep nor control
the diarrhoea. While it produces temporary comfort, the
disorganizing and blocking up of the secretory organs will
overbalance the temporary comfort resulting from its use.

Fever.

The regulating of the temperature is to be carefully di-
rected. I believe that harm has been done by our too ener-
getic measures for its reduction. To plunge our patient into
ice water is too heroic for me. Hydro-therapy is to be com-
mended, where we have a trained nurse to apply it, but is
oftentimes useless or even harmful as applied by untrained
hands or sympathetic friends. Undei- these conditions we
not only fail to reduce the fever, but exhaust the patient In
our efforts. Under certain circumstances we are forced to
some other means of reducing the fever, or not reduce it at
all. That we have gone to the extreme in our condemnation
of the antipyretic drugs I believe we are beginning to admit.
I sometimes find that I am forced to use them if any reduc-
tion of the fever is procured; and I have seen none of the
alarming depression of which we are often told. They should
be used with care, and are not applicable to all patients ; but
under careful supervision I find they serve me well.

Complications.

The various complications to which these patients are
liable are too numerous and not within the scope of this paper ;
but intestinal hemorrhage is so much a part of this disease
that its consideration should be included. This is in my ex-
perience the most frequent cause of death, and I so rarely feel

466 FIFTY-FIFTH ANNUAL SESSION

SO helpless as in the presence of this complication. Morphine
hypodermicallj is the most rational means for its control.
The minimum amount of food should be given. Do not stim-
ulate unless the demand is imperative and extremely urgent,
and do not continue after the immediate danger is passed.
Your effort should be to maintain the blood pressure just as
lov7 as safety will permit. JSTormal saline solution is not
indicated as a routine measure. You should aid nature in
her efforts to stop bleeding, and a low blood pressure is the
most advantageous condition to maintain.

Prophylaxis.
We should be explicit in our directions to the members ol
the family likely to come in contact with the patient, regard-
ing the dangers from the excreta, and the care they should
exercise not to carry it to their mouths or well or anywhere
that it might become a source of danger. The hands should
be disinfected after each handling of the patient. The dis-
charges should be disinfected and then buried, so that flies
can not get to them. Your responsibility is great and we owe
it to our friends to fully direct them in the details of prophy-
laxis.

Convalescence.

I do not allow any change of diet for one week after the
temperature has returned to normal, and then only semi-
solids for the next week; after this time solid food may be
added by degrees. The patient should remain in bed for ten
days after the disappearance of any fever.

N. C. MEDICAL SOCIETY. 467

MILK SICK AND MILK SICKNESS.

BY J. A. REAGAN, M.D., WEAVERVILLE, N. C.

The thing causing the disease, for want of a better name,
is called milk sick; the disease milk sickness. Now, what is
it that causes that sickness ? This is easier asked than an-
swered. There has been more time and scientific labor spent
in trying to find out what kind of poison it is than any other
poison known, and yet it goes without any better name.

This poison, whatever it may be, differs from all the known
poisons. It may lie quietly in the system for some time with-
out exhibiting any of its toxical powers, until the person or
beast is forced to take exercise. It is more ethereal and de-
lusive than any poison with which I am acquainted. Hence
it may be said to be sui generis. A Mr. Hall and wife on
Goose Creek died from eating a chicken that had picked
some flesh from a cow that died of milk sickness. A respect-
able citizen living on the same creek had put up his hogs in
a lot to fatten them. When one of his cows seemed a little
sick he put her in the same lot with his hogs. The cow died
and the hogs ate some of her flesh and he lost thirty head of
his hogs. A respectable citizen living some years ago says
he has seen as many as seventy dead buzzards around a dead
cow, besides several sick, but not dead. These cases show
this poison exceedingly dangerous.

Above Nashville, Tenn., there is a creek in the hills called
Goose Creek, On one branch of this creek is a fine range
and a great many head of cattle and mules were turned in
for the winter. Dr. Yandell, father of Professor Yandell,
of Louisville Medical College for many years, says : "One
of my neighbors concluded to winter his mules on this point,
as the green cane was very abundant, believing that nothing
could poison a mule ; but to his utter astonishment two or
three out of five died."

468 FIFTY-FIFTH ANNUAL, SESSION

Captain William Thompson drove bis cattle to this knob
some years ago for the purpose of wintering them. They
seemed to do well during the winter, but in the spring when
he started to drive them home thirteen out of twenty died
before he got home with them,

I think it best to say that exercise, either of man or beast,
develops the latent poison in a few hours; hence it is best to
exercise all animals intended for food before killing them.
I do not deem it necessary to enter into a minute description
of places where it is found, as it is only proper to say it is
always found, so far as I can learn, in loose, loamy moun-
tain sections where the timber shades the ground. In 1848,
when I first came to JSTorth Carolina, there was in the moun-
tains of most of this western range more or less milk sickness
found. Now that the country has been cleared up it is a
rare thing to hear of a case of milk sickness.

Dr. Woodfin was an educated physician who practiced
mostly in Macon County. I went with him to see a case of
milk sickness, and I am certain I never want to see a man
suffer as he did. Two stout men were holding him in the
bed, but frequently had to call for a third to keep him there.
He would have suffered no more if he had been on a bed of
hot embers. I never before or since saw a man suffer as he
did.

There is more credit due the physicians of l^ashville,
Tenn., than any other place for the work done in seeking the
cause of so many deaths of stock and persons. They finally
located the place and fenced it in, then stock were turned out
without fear; but yet the question as to what it is was not
answered. Some said it was a vegetable, others thought it a
mineral of some kind. They in a body went over the whole
enclosure and every vegetable whose properties were not fully
known was sent to Philadelphia to the chemist, who analyzed
all sent, and his report was short: "'No poison in any sent."
But this did not satisfy the good men and physicians engaged
in trvins: to fiud out what killed the stock.

N, C. MEDICAL SOCIETY. 469

They then brought up hay from a farm below aud put it iu
the enclosure and let it remain till after daylight ; took it out
and fed it to a cow with the dew still on it. She died. They
skinned her, hung the hide in a barn. The rats ate the pulp
and it killed them ; the hogs ate the cow and they died. It
is known that a hog is harder to kill with poison than any
other animal.

Dr. Hardwick told me that when a boy he had to take slops
to a sow down with kidney worm, some distance from the
house. He said he put a spoonful of arsenic in the slops to
kill her. His father told him the next morning to take some
food to the sow, but he said, 'Tather, she is dead by this time;
she was very bad yesterday evening." But his father made
him go, and to his astonishment he met her coming home.
The arsenic cured instead of killing, as he expected.

But the buzzards ate the hogs and died. I know of no
other poison passing through three animals to kill the buz-
zards. I do not suppose anything will eat a buzzard.

I regard that it is settled that milk sick is a gas that rises
from the ground and settles on vegetation. What the gas
comes from has not been discovered as yet. Dr. Mentlow
says the milk sickness has prevailed as far back as 1812. It
was then called ''the puking fever" as all or most all throw up.

Before I close this communication or article I think it
proper to give the most prominent symptoms of this fright-
ful disease. One of the earliest symptoms is a weakness in
the calves of the legs and general lassitude after taking anj'
exercise. They sometimes yawai and stretch as if going to
have a chill ; this is followed by pain in the back and head
and a disagreeable sensation about the stomach, and more or
less thirst. Then we have more or less fever ; then the thirst
increases until it is intolerable. The bowels become consti-
pated and are hard to move ; the pulse increases in frequence ;
the headache unbearable ; the patient rolling from side to
side of the bed straining to vomit every few minutes, calling
incessantly for water. These are the general symptoms. The

470 FIFTY-FIFTH ANNUAL SESSION

treatment then was large doses of calomel and blisters over
the stomach. But I have found the best and surest remedy
is about equal parts of honey and peach brandy mixed, and
given as required. With this remedy I have never lost a
patient. Of course the bowels must be regulated, even if we
have to resort to croton oil, but I have never had to do that
but once. I have not had a great number of patients, but
never lost one. In convalescence care must be taken to have
a good nurse that will watch the patient and not let him hurt
himself if he should become hard to manage.

I unfortunately once had an attack by eating a little but-
ter at supper in a section where there was at that time a
little milk sickness ; and singular to say I felt the symptoms
for three years at the same time of the year. Since then I
have had no symptom of the disease, and I shall be very
thankful if I never have even the shadow of the symptoms.

N. C. MEDICAL. SOCIETY. 471

THE NECESSITY OF QUARANTINE IN PNEU-
MONIA.

BY CHAS. B. WILKEESON, M.D., APEX, N. C.

In this paper I advocate no new theory but one which has
in no way been perfected by the profession. I have selected
no new disease but one which, by its high increasing mortal-
ity, has become the champion of all diseases of death.

The term pneumonia is still looked upon by some as an
anatomical, not an etiological disease, for it is by no meajis
settled that the disease is not produced by a large number of
the various forms of bacteria. These bacteria are the im-
mediate cause of pneumonia, the intermediate or predisposing
causes, being numerous and imperfectly understood ; but the
principal one to be considered is that indefinite idea, summed
up in the term "catching cold," believed by the laity to be
the prime cause of the disease ; but in truth we look upon
catching cold as a predisposing factor to infection; and as
some form of bacteria is always found in the respiratoi^ tract,
gathered from the air we breathe, the frequency of invasion
of the lungs is explained. But, granting this to be true, I
prefer to limit my paper to the broncho and croupous forms
of pneumonia, the immediate cause of the larger per cent of
which is the pneumococcus ; for from this infection comes the
endemics and the epidemic.

Most hospitals and institutions for the care of the sick ob-
serve some form of quarantine for their pneumonia patients,
especially in the maternity wards, and since the endemic
during January, 1908. In my practice I am convinced that
we, as general practitioners, should adopt it as our first treat-
ment in every case of pneumonia, for who is so perfect with
symptoms and diagnosis to say what cr.sc is the beginning of
an epidemic ?

Why should we quarantine pneumonia ?

472 FIFTY-riFTH ANNUAL SESSION

1. Distrihuiion. — Hare says: ''There is no doubt that it
is the most common of all acute infections." Osier says : ''It
is the most widespread of all acute diseases." And in fact
most authors are agreed on this point.

Therefore we must agree that pneumonia is the most gen-
eral of all acute infectious diseases, found in all climates,
especially the damp; during all seasons, but most prevalent
during the winter and earlier spring months. It attacks more
people of all ages than any other acute infectious disease. It
visits the cradle of the babe, and hovers over the couch of the
aged, while no person is exempt between these two extremes.

2. Fatality. — Pneumonia is the most fatal of all acute in-
fectious diseases. The census for 1900 shows a mortality of
105,971, and during the epidemic in the spring of 1903, there
were more deaths from this disease than from all other pre-
ventable diseases, and each year the mortality is increasing,
endemics and epidemics becoming more frequent ; and to-day,
with all our medical skill, it continues to increase, even higher
than when the pathological changes of the disease were un-
known.

3. No Specific. — With all our therapeutical knowledge no
one has been able to give to our profession a specific to check
the onslaught of this disease, when once the person has become
infected. The physician can only guide the patient to a fa-
vorable crisis or lysis.

Then, knowing the helpless condition in which the physi-
cian is so often placed, it appears to me that at the present
time, with no specific for this disease, our only hope to benefit
mankind and lessen the mortality is through a quarantine
system lessening the number infected.

4. Sequence. — Unlike many of the acute infectious dis-
eases one attack does not confer immunity, but predisposes
to subsequent attacks, which lowers the vitality of the lung
tissue, leaving the individual in a more susceptible condition
for other infections. Influenza sets the pace, pneumonia
hastens the gait of lowering the vitality, and tuberculosis closes

N. C. MEDICAL SOCIETY. 473

the scene of many a life, for it is tlirough this channel of
sequences that a large nnmber of tnbercular patients have
drifted.

Then to sum up, the nnmber of people infected, the high in-
creasing mortality, no specific treatment and the serious se-
quence, we must conclude that some form of quarantine is
absolutely necessary and is the only hope at present of re-
ducing the death rate.

Whatever form of quarantine we should adopt should be
rigidly enforced against individuals who are already suffering
with some of the predisposing factors, as old age, overwork,
alcoholism, typhoid fever, influenza, bronchitis, diabetes,
tuberculosis, visceral diseases, chronic nephritis or, in fact,
any disease which lowers the vitality, for from these comes the
high mortality and not from the robust. jSTo one contends
that every case of pneumonia is contracted from another, or
that every one that comes in contact with an infected person
contracts the disease, for the germ pneumococcus has been
demonstrated in the mouths of healthy individuals, the vi-
tality of the person being such as to overcome the virulence
of the germ present, but by sudden exposure to cold or trau-
matism this germ gains an entrance and the individual be-
comes infected; and after the germ, having multiplied both
in number and virulence in this subject, another individual
of like vitality may quickly succumb to the disease without
exposure.

Furthermore, the healthy individual whose air passages are
in perfect physiological condition may be intimately associ-
ated with a virulent infection and not succumb to the disease,
for the vitality of such a person surpasses the virulence of
the invading germ. The healthy nurse and doctor usually
come under this head ; but even these, by losing sleep, sudden
changes in temperature, or by breathing the dust of a shaken
carpet of a room, lowering the vitality of some part of the air
passages, may become infected.

Hare says: "There is no doubt that the disease is capable

i74 FIFTY-FIFTH ANNUAL, SESSION

of being spread from one to another, and especially to patients
suffering with other constitutional diseases, the vitality hav-
ing already been lowered, for eight out of eleven of my ty-
phoid patients were infected by admitting one croupous pneu-
monia patient into the ward." Osier says : ''At times it may
assume epidemic proportions or may be endemic to a family
or school." Caille gives the following definition : "An acute
infectious endemic and epidemic disease, beginning with a
chill." In fact, all authors I have consulted agree that the
disease may spread from one to another, but none insist on a
strict quarantine, as in smallpox, a disease which at the pres-
ent day, by the use of the specific vaccine, has a mortality
less than two per cent, or one-tenth as high as pneumonia.

In order that you may understand my attitude more fully
I will give you a report of some of the cases that convinced
me that pneumonia is always infectious, and, after having
multiplied in number and gained in virulence in proportion
to the number of subjects it has passed through, becomes con-
tagious :

January 15th my colleague was called to see a schoolboy
suffering with pneumonia. This boy was attending a free
school in the rural section. On January 18th I was called to
see another student of this school, a boy fifteen years old, and
a chum of the boy already infected, suffering with croupous
pneumonia, a very virulent infection. The older brother,
room-mate and close attendant to his younger brother, on Jan-
uary 24th became infected with croupous pneumonia. The
infection was much more virulent in this case than in the
preceding. This family was composed of these two boys al-
ready infected, a sister thirteen years old and two younger
brothers, six and eight years old. I immediately ordered
that these two younger boys and sister be sent away ; but, as
the father and mother felt that they could not dispense with
the services of the daughter, she was kept at home to help
nurse those already sick.

January 28th this girl was taken with a chill, and a violent
case of croupous pneumonia of both lungs followed.

N. C. MEDICAL SOCIETY. 475

Special to note was the fact that the germ became more
virulent as it passed through the different victims, for each
one affected was worse than the preceding one. The younger
brothers, six and eight years old, who were not allowed in the
room at the beginning and later were sent away from home,
escaped the infection, although suffering with colds, making
them more susceptible both on account of age and lowered
vitality.

There were several other cases from this same school which
I am unable to report, as they did not come under my charge,
but it is evident that this infection began in this school, and
with an enrollment of some forty or fifty pupils five per cent
or more became infected with pneumonia ; but, as you may
have noted, not all infected at one time, but from the original
infection the disease spread.

January 16th, called to see a woman, Mrs. M. . . . ; mar-
ried lad}^, suffering with broncho-pneumonia of both lungs;
pregnant seven months ; weighed two hundred and twenty-five
pounds, with heart and kidney complications. The family,
as soon as I gave out the diagnosis, immediately sent for her
younger sister to nurse her. On January 2 2d the patient
died ; the same afternoon the younger sister nurse became
infected with the same type of pneumonia. During the sick-
ness of the last-named case a young girl twelve years old was
continually in and out of the sick-room, carrying things
needed and assisting in nursing the patient. January 25th
she became infected, and another case of broncho-pneumonia
developed.

The special point I wish to emphasize is the fact that the
infection from the school was croupous pneumonia, and as
the infection spread it did not change the type of the pneu-
monia, but each suffered alike.

The family last reported had broncho-pneumonia, and each
one infected presented the same type, both lungs being in-
fected in each case, showing that the germ present produced
this one form of pneumonia. This is suggestive that each
pneumonia had its specific germ.

476 FIFTY-FIFTH ANNUAL SESSION

There may be some who think I am taking a rather radical
stand on the spread of this disease, but in reply to this I will
ask the question, In what otlier way are we to lower the death
rate of this most dreaded infection ? My answer is, by a
system of quarantine lessening the number infected.

Whetlier the disease is contagious or not, the fact remains
that no pneumonia exists unless produced by some form of
bacteria.

Their destruction outside of the body, sliould we know
liow" and where to find them, would mean a great deal for
prophylaxis, and any patient infected should always be con-
sidered a source of multiplication of these bacteria and of the
consequent propagation of the disease. Therefore every pre-
caution possible should be taken with those of lowered vital-
ity, both for direct and indirect contagion.

But the point I wish to stress is the duty of the family phy-
sician in pneumonia. He is the man who has to battle with
life and death against this much dreaded disease, and it is
through and by him that relief must come. The family should
be instructed as to the prophylaxis necessary to protect them,
while the doctor should let quarantine be second to diagnosis
in his treatment.

In closing, considering the fact that more people die from
pneumonia than from any other infectious disease, that it is
a forerunner of tuberculosis, the mortality of which is second
to none except pneumonia; that the mortality is increasing;
that at present we have no specific with whicli to check its for-
ward march ; that it is a complication of most all diseases of
childhood, I contend that it is time for our profession to
adopt a systematic quarantine, and while making such
thorough investigations of tuberculosis we should try to pre-
vent the spread of pneumonia.

N. C. MEDICAL SOCIETY. 477

THE EXAMINEE'S GOLDEX RULES FOR LIFE IN-
SURANCE WORK.

BY ALBERT ANDERSON, M.D.,

Medical Director Jefferson Standard Life Insurance Company, Raleigh, N. C.

''A Declaration of Independence for the Family" is the
fundamental principle and keynote to life insurance. With
this in view we should be always on the alert to conserve its
interest and promote its development; to do this I do not
know a department that has more to do to gain this end than
the medical. Therefore, whatever rules that promote and
conserve its interest and development are golden. We want
to hew to the line, give "precept upon precept, here a little
and there a little," till in our bulletins and journals these
rules are thoroughly impressed upon the mind and observed
in the work of medical examiners.

Your first impression in meeting an applicant should radi-
ate like the spokes of a wheel to the circumference of his
entire personality wdth regard to his manners, expression,
color, countenance, gait, speech, hand-grasps, occupation-
marks, dress, sequela? of recent illness, present condition of
physique, etc.

Do this in a way as to make the applicant feel that he is
in the presence of a congenial friend as well as an examiner.

Put your subject forefront to the light.

Do your work in the quietest obtainable place.

Observe the rule of lovers — be alone — and don't allow the
presence of any other party or parties, except the presence
of the husband or lady friend during the physical examina-
tion of a female applicant.

Be sure he understands the meaning of all questions.

Arrange the clothing so that your inspection and examina-
tion can cover the entire chest with minuteness.

Know the specimen of urine gotten was the applicant's and
his identity beyond question.

478 FIFTY-FIFTH ANNUAL SESSION

Begin with the first question and take them in order to the
last, and then review for the purpose of determining that
there are no errors or omissions, no ambiguity or obscurity.

Learn to be rapid, yet thorough and concise in your report.

Is there any necessity for special instruction for this work,
considering the four years course in our best medical schools ?
I think so, and I have learned that in the last four years
many colleges and post-graduate schools have introduced into
their curriculum a special course for medical examiners. In-
surance companies welcome this because of its need. The doc-
tor has been trained for the consideration of diseases, not for
the consideration of "average health" — a patient seeking after
health through the counsel of a doctor, his training has led
him not to weigh and determine the truth of statements of a
man applying for life insurance. To a great many applicants
a life insurance company is impersonal and a soulless corpo-
ration out of which they may be permitted to extract a few
thousand dollars on the payment of a few premiums without
hurt to conscience, but with commendation of his foresight
by friends and loved ones enjoying this fruitage.

The relations between agent and examiner are regarded
either too antagonistic or too sympathetic. There should be
the "golden mean," and this comes through tact, affability,
"suaviter in modof hold absolutely to the interest of your
company and be pleasant, reasonable and polite to agents in
rejecting their applicants. To do all this successfully de-
mands special training of our examiners, for the possession
of this knowledge or power does not come through intuition
or spontaneity.

As to identity an honest and intelligent examiner can de-
tect an impostor, because criminals are fortunately only cun-
ning, but not intelligent.

An elaborate technique is not at all necessary to arrive at
a definite idea of the physical condition. To loiow the normal
well is necessary in order to recognize the abnormal. As sug-
gested above precision and rapidity are the main points to

N. C. MEDICAL SOCIETY. 479

cultivate in insurance work. The entire chest should be ex-
amined in every case. Don't make the mistake that it takes
too much time to do a careful and systematic examination.
System and skill take less time than an examination made
without following a correct method. To summarize, I would
say accurate technique, eyesight and hearing, a practiced
hand, a knowledge of anatomical landmarks of the chest, and
to know the physical signs of health and disease are the essen-
tials of equipment.

The clothing must be properly arranged to examine the
chest thoroughly; and I mean by this to remove them and
have the whole chest exposed — ^to roll up the shirts under the
armpits wdll cover the apices of the lungs — the very area
where tuberculosis begins. Experts say that it is impossible
for them to detect the crepitation of an incipient tuberculosis
through starched linen. My plan is to remove clothing down
to the waist with exception of the lower undershirt, which
can be opened and rolled back out of the way so as to bring
into view every part of the naked chest. In women, remove
corset and other articles of dress or so adjust them as to per-
mit a thorough examination — exposing the upper chest and
shoulders ; and this can be done in a way to gain the consent
of applicant and give no offense to the modesty of any sensi-
ble woman. Right here I would suggest that you use your
best tact and judgment in the different steps of your work,
and this can be done in a way to allow you to go forward in
your examination to completion with mutual interest.

Bear in mind the fact that it is not the acute infectious
diseases that play havoc with our mortality rates, but early
and destructive mortality comes from chronic diseases that
ought to be discovered and rejected, and thus save three-
quarters of the actual mortality for the first year or two due
to these underlying conditions discoverable by following the
above suggestions. You can see the importance of this from
the viewpoint of justice to the policy-holder in properly grad-
ing applicants. Invalid lives, average lives and sound men

480 FIFTY-FIFTH ANNUAL SESSION

of untainted stock, all thrown into one class, make premium
rates higher than they should be for the latter class.

Heart disease and its kindred troubles should not appear
to any appreciable extent for at least five years after the is-
suance of a policy, if the physical examination be properly
made, is declared by Greene, and yet he gives statistics from
both British and American tables that these troubles com-
menced during the first year, and cites eleven cases in his
book coming under his own observation within six weeks to
two years ; and further states the list could easily be quad-
rupled.

These mistakes are made among examiners of all companies
and the causes are chargeable primarily to the companies. The
examiners are not sufficiently impressed with the idea that
their work is all-important and official. Why we pay the
liberal fee of five dollars for each examination is because we
want a man competent and reliable, with a sense of responsi-
bility resting upon him as a commissioned ofiicer. Another
cause is said to be the lack of definiteness in the company's
requirements. We put such questions in our examination
blanks which we think are the most important to get all the
necessary information, but every competent examiner should
not only answer every question but, after doing this, if he
knows any other necessary information should give it, or he
fails to meet his responsibility and earn his fee. Failing
to detect incipient tuberculosis or heart disease has cost in-
surance companies millions of dollars, and this failure comes
from lack of a proper place in which to examine, as well a?
incompetency or carelessness of the examiner.

N. C. MEDICAL SOCIETY. 481

KECIPROCITY.

BY A. A. KENT, M.D., LENOIR, N. C.
Ex-Presideut N. C. «late Board of Medical Examiners.

Reciprocity between States as applied to the practice of
medici'ic ^^iiettiis an agreement between two State Boards of
Examinoi'.s, by wbicb each will recognize tbe license granted
by tbe other and grant to the holder of such license from one
State the license to practice medicine in the other State with-
out a second examination. For example, tbe Iowa Board
will recognize tbe license granted by the ISTorth Carolina
Board and grant a license to practice in the State of Iowa to
an applicant holding a license from the jSTorth Carolina Board
without requiring the applicant to stand an examination be-
fore the Iowa Board, This upon the surface seems to be a
very simple proposition, and much to be desired by doctors
moving from one State to another. Only a very few of the
best qualified doctors could pass these examinations after they
have been out in practice a few years without first taking a
special course of study to prepare themselves again upon the
fundamental branches. At first we wonder why it has not
long ago become common custom. When we investigate the
question we find it to be attended wath many obstacles, com-
plications and dangers, some of which are almost insurmount-
able.

If there were but a few States and all had for years main-
tained a someW'hat uniform standard of requirement, and if
all applicants were capable and honest, it would be an easy
proposition. But we must remember that there are now in
the United States fifty-one political divisions, and that the
conditions and environments in these many divisions differ
widely, making very different standards of requirement nec-
essary. The legislation in each has grown up somewhat spo-
radically, many times more in conformity to the ideas of the
laity and nonprofessional legislators than to the ideas of. medi-
31

482 FIFTY-FIFTH ANNUAL SESSION

cal men. Some States have a single board, in some there are
mixed boards, in others two or three boards, our State having
two boards at this time. In some the diflferent sects are recog-
nized in one way, in others in some other way. In some a
high standard has been rigidly maintained for a long time, in
others for only a short while, and in yet others such a stand-
ard has not been attained. While the legislation of the sev-
eral States has a general tendency upward and toward uni-
formity, it is more or less chaotic and unstable. Such being
the general condition throughout the States, reciprocity should
be embraced by ISTorth Carolina with a great deal of careful
reserve and prudence.

Every State has absolute control of its own domain in all
matters of police regulation, the practice of medicine being
one of them. It has the right to fix the standard that it will
require of its own citizens and others primarily licensed in
the State. It also has the right to say whether or not it will
recognize the license granted in another State ; and if so, to
fix the terms upon which it will grant such recognition. This
power has generally been vested by the States in a board of
health or a board of medical examiners.

The Board of Medical Examiners of ISTorth Carolina, hav-
ing been created by act of the Legislature of 1858-1859, is
the oldest medical examining board that' has been in continu-
ous existence in any of the States. The medical profession
of the State has always enjoyed great privileges and likewise
great responsibilities. We control ourselves. We have been
the authors of all important laws governing and promoting
the practice of medicine in the State. The doctors have like-
wise been the authors of all important legislation of the State
for the protection of the public health. While we have inci-
dentally safeguarded the interests of the profession, we have
always made the protection of the people and the public health
of the State of first importance. The conditions and environ-
ments of the State being considered, our medical laws are
about as good as we could wish for. We have also reached

N. C. MEDICAL SOCIETY. 483

the time when our State boys, who are homogeneous with the
people, are not only supplying the needs of the State, but are
crowding one another in the profession. We do not need to
open a new and e&sj w^ay of entrance into the profession in
order to supplement the supply of doctors.

But we are living in an age of progress and must keep pace
with the times. ^Yhile we must safeguard with jealous care
against the entrance of undesirable outsiders, we must not
shut ourselves within a wall, refusing to recogiiize the better
class of doctors w'ho come to us from other States, thus cre-
ating the impression that we are trying to maintain a monop-
oly, and w^orking prejudice against our own licentiates, who
will in the future be moving to other States in greater num-
bers than we receive in return.

This matter of reciprocity is with us and will not be
brushed aside or smothered dowm, even if w'c desired to do
so. In many of the States it is an established fact, and in
common practice. As many as fifty reciprocal licenses per
year have been gi-anted by some of the States. It is in keep-
ing with the greatly increased facilities for better and more
general knowledge in regard to all sections of the country.
Sentiment in favor of it is growing rapidly in all the States.
There are at this time some five or six national organizations
that come together annually and discuss this question with a
view to establishing a uniform standard of requirement and
general reciprocity. There exists such a diversity of environ-
ment that it will be many years before such a uniform stand-
dard can be secured and maintained in all the States. But
the w^ork along this line has disseminated much knowledge,
and has created such a widespread and popular demand upon
us at this time as can scarcely be resisted.

The law which was enacted by our last Legislature upon
this subject was in obedience to this popular demand, and not
desired by the profession in the State. In fact, it was re-
sisted by the profession upon the belief that the demand at
that time was being made by a few^ undesirable persons, who

484 FIFTY-FIFTH ANNUAL SESSION

hoped by means of reciprocity to evade our careful examina-
tions and obtain an easy entrance to the profession in the
State. In fact, there was no evidence at that time that there
was a general desire on the part of the people to open new
and easy portals into the profession, and thus meet any de-
mand for an increase in the supply of doctors for the State.
However that may have been, we were in great danger of un-
conditional recognition of all license of the other States, with-
out discrimination, being forced upon us by act of the Legis-
lature. Thanks and praise be to Dr. K. H. Lewis, of Kaleigh.
that this legislation was so directed as to leave the matter of
reciprocity in the discretion of the State Board of Medical
Examiners. We were very fortunate in having a wise and
patriotic member of the profession in our capital city at that
time, as in many other instances, to take care of our inter-
ests. If the effort to force unconditional recognition of the
licenses of all the other States upon us had been successful
]^orth Carolina would soon have been flooded with the un-
desirable from all sections of the country.

Your Board of Examiners at its last meeting formulated
a set of rules for reciprocity that would admit to the profes-
sion in this State those applicants from other States holding
a license from States having a standard of requirement equal
to our own. To have admitted those who had obtained a
license from a State with a lower standard would obviously
be discriminating against those who were offering to pass
before our own board, against our own boys. This would be
unjust, and would ultimately force our boys to go before the
boards in other States with lower standards and then come
to l^orth Carolina and demand that the license from the other
State shall be recognized. As our standard is higher than that
of all but two or three States we could only reciprocate in a
very limited way. We can, I think with safety, say we will
recognize the license of an applicant from another State who
upon examination made a grade as high or higher than our
standard of requirement. This would enable us to recipro-

N. C. MEDICAL SOCIETY. 485

cate with most of the States, and would be greatly to the ad-
vantage of our licentiates who wish to remove to States hav-
ing a lower standard than ours.

The matter of reciprocity or recognition of the license
granted by another State Board should always be put in the
hands of the State's Licensing Board. While there should
be some conference and general agi-eement on the part of our
State Board with the boards of other States as to reciprocity,
it should be understood by both that it is to be reciprocity for
the benefit of the hona fide doctors of each State of the de-
sirable class, and not for the purpose of opening an easy ave-
nue into the profession in either State of the undesirable
class. We only want the better class who may come to us
from other States, and not just any who may hold a license.
On the other hand, we should be discreet in the class of men
that we recommend to the other States for reciprocity. There
are good and bad in the medical profession as well as in other
avocations in all of the States. We should stand ready to
receive the good, and at the same time discriminate against
the incapable and the bad. It should always be kept in mind
that the undesirable are apt to be the first to try to avail
themselves of it. They will always be the most numerous and
the most clamorous for it.

Our board should have a very complete and comprehensive
form for the applicant to fill out upon making his applica-
tion. Without this very important matters of requirement
are apt to be lost sight of. ISTo license obtained other than by
examination should ever be recognized by our State. The
photograph system for identification should be adopted and
strictly adhered to ; and all other safeguards against cheating
and fraud employed. It would be well for the secretary of
the board to be empowered to administer an oath to all appli-
cants for examination as well as reciprocity to the effect that
the applicant is the person that he represents himself to be;
that he is the rightful owner of the license and diploma which
he holds, and that he is not addicted to any drink or drug

486 FIFTY-FIFTH ANNUAL SESSION

habit to the extent of impairing his usefulness as a practicing-
physician.

ISTo State Board should ever undertake to examine the re-
cently graduated citizens of another State and recommend
them for reciprocity ; nor should any State eA'er allow its citi-
zens who have recently graduated to obtain license before
the Board in a Sister State and then come to the home State
and demand recognition on the grounds of reciprocity. If
one could go before the board in a sister State, pass the ex-
aminations and obtain a license that would entitle him to
practice in the home State, there would soon be a scramble
to get before the board that had a reputation for being easy
to pass. There would be no chance for the preferment of
charges against the man of bad character, for no one could
know when or what board he would appear before. Substi-
tuting and other cheating could be carried on with less risk
of detection. It should always be restricted to individual
cases, and exercised upon a high plane. If properly conducted
upon a high level of professional honor, dignity and courtesy
it will be of great advantage to the worthy doctor w^ho is mov-
ing from one State to another. It sliould be well understood
that it is for his benefit and for him only. It will not only
save him great embarrassment, but also the expense, labor
iind time necessary to preparation for a second examination

N. C. MEDICAL SOCIETY. 487

SUKGICAL CONSCIENCE.

BY JOHN C. RODMAN, M.D., WASHINGTON, N. C.

President N. C. State Board of Medical Examiners.

In searching the labyrinth of thought and delving into the
recesses of memory for an idea, a subject or a title, the evolu-
tion and development of which, according to my views and ex-
perience, might prove interesting and instructive to this So-
ciety, there have passed before my mental vision many ques-
tions, old and new, which are of vital importance and fasci-
nating interest alike to the profession and to the public at
large.

But upon reflection it would seem that if I could bring to
you new and different thoughts, even upon an old and time-
worn subject, my efforts in this direction would not prove
to be entirely wnthout success.

Wmdd that my knowledge were greater, my wisdom more
profound, and ex]ierience, the greatest of all teachers, had
been upon a broader and wader plane. Then, perchance, I
would have approached the subject with more temerity, hav-
ing greater confidence in my ability to impress j'ou with the
fact that, though this question does not bristle with vaunted
theories of unsolved scientific problems, nor of remarkable
and brilliant operative procedures. Yet it is a question of vast
concern, both to the individual patient and to the professional
man ; to the former, for he is the ultimate sufferer or bene-
ficiary ; to the latter, for he becomes a better man, a better
physician by the possession and cultivation of what, for a bet
ter term, I shall call "the surgical conscience."

I do not mean to convey the idea that I am using the word
conscience solely as it is ordinarily accepted, "the sense of
right and wrong," but more than this is implied in the surgi-
cal conscience, which I shall define, as that faculty or charac-
teristic or what not of the surgeon who, after having made a
diagnosis of the pathological conditions, will have the courage

488 FIFTY-FIFTH ANNUAL SESSION

of his convictions and so act that always he shall do that which
in his inner self he believes to be for the best interest of his
patient, without regard for the adverse criticism of friend
or foe, self-emolument or professional advancement.

In this progressive era of aggressive surgical procedure,
the temptation is ofttimes strong to do something active, some-
thing radical, perchance to avoid the unfriendly criticism of
the so-called friends of the patient, who insistently insinuate
that Mr. A or Mr. B has been recently operated upon for the
same trouble and is now out again well and strong ; or maybe
to receive the plaudits and commendation of our admirers
and supporters, who would give us the reputation for being
bold and daring surgeons. ]^o matter the after-result, who
knows when an unsexed and childish woman mourns in secret
the sad decree of fate were the best really done ?

Upon the other hand, in the rush and hurry of professional
work, not quite sure as to diagnosis, when our cares and re-
sponsibilities seem greater than we can bear, a w^aiting policy,
an expectant plan of treatment, may tempt us to put off for to-
morrow what future events may prove should have been done
to-day, and the result, unpleasant retrospection ; in truth, the
effects of the surgical conscience. The statistics of deaths
from appendicitis will give to the procrastinating operator
room for much reflection and self-criticism, if he cares to enter
that uninviting field. The remedy for the preventable death
of unrecognized ectopic gestation would seem to the inquiring
mind clearly to be the cultivation and improvement in the
art of diagnosis, and diagTiosis is the foundation of the science
of medicine.

The early history of medicine shows that the objective class
of systems w^cre taken more into consideration in arriving at
a conclusion as to the nature of the ailment than other things.
The color of the urine, the odor of the sweat, the expression
of the countenance, etc., were deemed sufficient for the man
of reputation and skill. Time has changed much since then,
though even now we hear of Dr. 0, of D, who is a natural-

N. C. MEDICAL SOCIETY. 489

born physician, having cultivated the power of observation
to such an extent that he has only to look at the patient to
be able to tell what the trouble is ; or treating symptoms as
they arise, paying especial attention to the niceties of the pro-
fession, those with a goodly share of practical judgment may
achieve reputation and success, but never will the depth of
their knowledge allow them to have the courage of their con-
victions, to conscientiously treat medical and surgical cases,
with due regard to the sins of omission as well as the sins of
commission.

Far safer is the man and less likely is he to have unpleasant
retrospection if in early life he avails himself of every method,
of every procedure known to the profession, using his powers
for thinking, reasoning, analyzing and deducing to make a
diagnosis, or attempt to, even in a case of the simplest char-
acter. Should this diagnosis be wrong a lesson will have been
well learned, and each lesson makes the better physician, the
better surgeon.

In my own professional work nothing has been of more ad-
vantage to me than having received a local appointment as
acting assistant surgeon in the Public Health and Marine
Hospital service, and for the past four years treating the pa-
tients of the service. In all this work a diagnosis has to be
made and put on record ; no more terms of "a. little bilious-
ness," ''gastric fever," "congestion of the bowels," etc., in the
hurry of practice. A habit of satisfying your own mind at
least of the nature of the disease in every case is certainly a
good one to form. I am trying to cultivate it more and more
all the time.

Surgery of to-day has reached heights never dreamed of a
decade or two ago. The field is broadening all the time, and
cases hitherto considered entirely in the medical class have
now been transferred to that of the surgical, and the reason
for this is the improvement in the art of diagnosis, that accu-
rate knowledge which carries with it the ofttimes delicate
distinction of knowing when and when not to operate.

490 FIFTY-FIFTH ANNUAL SESSION

Mechanical operative dexterity is an accomplishment pos-
sessed by many whose years in the profession have been bnt
few ; the really great surgeons are not only the dextrous, but
rather the profound students of the human mechanism, those
who have gone to the foundation and are most familiar with
the etiology and pathology of disease, and have availed them-
selves of every method known to science to get an exact knowl-
edge of the individual case. For I can but believe that the
most essential quality in the successful surgeon is that of ac-
curate diagnosis. For it ofttimes, beyond peradventure, des-
ignates the time for and against operative procedure, and the
more proficient the surgeon can make himself in this most
important branch of the science the less he will have cause
for future regret, and the more he will be possessed of the
"surgical conscience." Knowledge gives us confidence and
boldness, too ; and if tempered by the conservatism of wisdom
we have the ideal man.

"Knowledge and wisdom, far from being one.
Have, ofttimes, no connection. Knowledge dwells
In heads replete with thoughts of other men ;
Wisdom in minds attentive to their own.
Knowledge is proud that he has learnt so much;
Wisdom is humble, that Jie knows no more."

N. C. MEDICAL SOCIETY. 491

THE INFLUENCE OF THE GENEKAL CONDITION
OF THE PATIENT ON THE RESULT OF A SURGL
CAL OPERATION.

BY STUART McGUIRE, M.D.,
Professor Surgery University College of Medicine, lilehmond, Va.

There are some operations, such as for the relief of a stran-
gulated liernia or the removal of a gangrenous aj)pendix, which
are so urgently demanded for the immediate purpose of sav-
ing life that the surgeon has no choice, and nothing is con-
sidered but the one great need. These are imperative opera-
tions, and must be done regardless of risk. There are other
oprations, such as for the correction of deformities or the
relief of some chronic ailment, which, however desirable, are
not essential to the life of the patient. These are elective
operations, and should not be undertaken without carefully
considering the danger to be incurred on the one hand, and the
benefit to be hoped for on the other.

In estimating the risk of an operation the modern surgeon
is too apt to base his opinion on the statistics contained in
text-books and encyclopedias. Figures are proverbially un-
reliable. Thus, for instance, the statistics of old operations,
such as ligations and amputations, are usually a record of
preantiseptic surgery, and do not represent the work of to-day.
While the statistics of more recent operations, such as thy-
roidectomy or gastro-enterostomy, are usually the record of
master workmen like Kocher and Mayo, and do not represent
the danger of these operations in the hands of the average
surgeon.

In deciding whether or not to advise a patient to undergo
an elective operation the following factors should be con-
sidered :

First, the gravity of the operation and the relief to he ex-
pected from its successful issue. There is no operation de-
void of risk, and some are attended by great danger. Patients

492 FIFTY-FIPTH ANNUAL SESSION

are occasionally unreasonable and insist on having a serious
operation done to rid themselves of a fancied ailment. Unless
the operation is safe and there is a reasonable assurance of the
patient being materially benefited he should not be subjected
to a surgical ordeal.

Second, the ability and experience of the operator-. ISTo
courageous doctor should fail to undertake an operation if the
patient's condition is urgent, if delay means death, and if no
more experienced surgeon is available. Competency is a rela-
tive term, and the man on the ground should endeavor to
afford relief or else fails to measure up to his responsibility.
It is different, however, when the disease is a chronic one and
the patient could safely be moved to a hospital, or await the
arrival of a surgeon from a neighboring city. A patient is
entitled to the best possible prospect for prolonged life or re-
stored health that his resources permit. No conscientious
surgeon should undertake an operation without asking himself
whether he has the skill to do the work satisfactorily. In
many cases he can honestly answer the question in the affirm-
ative. In some cases, while there may be a doubt in his mind,
he is justified in operating by the fact that the patient has not
the physical strength to bear transportation or the financial
means to bring a surgeon from a distance. In other cases,
however, the surgeon must recognize his inferiority to men
in the profession who devote their lives to special lines of
work, and when the patient has the physical and pecuniary
power to secure their services, it is his duty to place the case
in their hands. This obligation is so universally recognized
that the sacrifice it entails is not often appreciated by the
laity, and sometimes not by the class of the profession which
is benefited.

Third, the general condition of the patient, or the consider-
ation of the personal factors in the individual case which in-
fluence the result of the operation. It is often said — some-
times seriously, sometimes satirically, and sometimes truly —
that the operation was a success, but the patient died. In

N. C. MEDICAL, SOCIETY. 493

such a case the indications for the operation may have been
plain, but the contra-indications were either overlooked or
disregarded. The operation may have completely corrected
the condition from which the patient suffered, it may have
been perfect in its technique and brilliant in its execution,
but the patient may have lost his life from some complication
which could have been foreseen by more careful preliminary
investigation. Many surgeons have had uncontrollable hemor-
rhage to follow the removal of a small tumor, owing to the
patient having hemophilia, or have had gangrene develop in
a wound, owing to the existence of diabetes, or have had sup-
pression of urine to follow, owing to the presence of nephritis.
Sir James Paget, in one of his classical lectures, says:

Never decide upon an operation, even of a trivial kind, without first
examining the patient as to the risk of his life. You should examine
him with at least as much care as you would for life insurance. It is
surely at least as important that a man should not die or suffer serious
damage after an operation as that his life should be safely insured for
a few hundred pounds.

Tw^o separate and independent examinations should be
made of every surgical patient: the first for the purpose of
diagnosis and the determination of the condition to be cor-
rected; and the second for the purpose of prognosis, or the
determination of the safety of the operation. In forming an
estimate of the latter, many factors have to be taken into con-
sideration, such as age, sex, race, habits of life, constitutional
diseases and visceral disorders. In discussing these under
separate headings much use has been made of an article by
Sir Frederick Treves, who acknowledges a similar indebted-
ness to Sir James Paget.

Age. As a general proposition it may be stated that pa-
tients at either extreme of life are poor subjects for surgery.

Children under five years of age take anesthetics badly;
often suffer severe shock from only moderate loss of blood,
and are difiicult to manage during convalescence. They are
liable to gastro-intestinal disturbances, especially in hot

494 FIFTY-Fli<TH ANNUAL SESSION

weather, and frequently are the victims of chickenpox, measles
or other infectious diseases to which they are susceptible. On
the other hand, owing to the energetic cell activity of t)ie
period of growth, their tissues heal rapidly and are not prone
to suppuration. In operating on children avoid, if possible,
the period of first dentition, as they are liable to digestive
disturbances and to convulsions, and apt to develop a high
temperature under little provocation. Use chloroform as an
anesthetic, and avoid the infliction of long-continued pain.
Es2:)ecial care should be taken to prevent loss of blood or body
heat. Dressings should be carefully watched and changed as
often as soiled. Usually no attempt should be made to keep
the child in bed, but from the first it should be permitted to
lie on the mother's lap or be carried about in her arms.

The period from the fifth to the fifteenth year is the golden
age of surgery. Here the mortality is least and the results
best from operations of almost every kind. This is due to the
fact that metabolic processes are active and resistance to in-
fection vigorous ; that the various organs of the body are nor-
mal and perform their functions satisfactorily; that the ner-
vous system is stable and uninfluenced by regrets for the past
or fears for the future ; and finally, that the reason and will
have developed sufficiently for the surgeon to secure the ac-
quiescence and cooperation of the patient.

Between the twentieth and fortieth years the mortality of
operations greatly increases. This is due to sexual develop-
ment, attended by the possibility of excesses, abnormalities
and diseases ; also to the cares and responsibilities of maturity,
often leading to neurasthenia from excessive w^ork and worry.
And finally, there may be superadded the injurious results of
addiction to tobacco, whiskey or opium.

After forty the mortality from operations is nearly three
times greater than in patients under twenty. As a rule, old
people are severely shocked by loss of blood or body heat;
their w^ounds heal slowly, and their tissues have little power
to resist infection. They are headstrong and rebellious and

N. C. MEDICAL, SOCIETY. 495

intolerant to confinement. Their organs of assimilation and
excretion are impaired, and their stomachs and kidneys liable
to break down. Taken all in all, old age is a gTeater bar to
surgery than any other complication, unless it be chronic
alcoholism. It must be remembered, however, that senility
is not measured in years. Surgically speaking a man is as
old as his arteries. In impressing this point Sir James Paget
says:

They that are fat and bloated, flabby of texture, torjjid, wheezy and
incapable of exercise, looking older than their years, are very bad.

They that are fat, florid and plethoric, firm-skinned and with good
muscular power, clear-headed and willing to work like younger men,
are not, indeed, good subjects for operations, but they are scarcely bad.

The old people that are thin and dry and tough, clear-voiced and
bright-eyed, with good stomachs and strong wills, muscular and active,
are not bad: they bear all but the largest operations very well.

The brilliant results of Young and others in operating on
:>ld men for prostatic enlargement show that modern surgery,
with its short period of anesthesia, diminished loss of blood,
freedom from infection and pro-^ision for adequate drainage
has made it safe to do operations on the aged which, only a
short time ago, would have been unjustifiable.

Sex. Other things being equal, women bear operations bet-
ter than men. This is due to the fact that they are designed
for maternity and are naturally endowed with more passive
endurance ; that they are more confiding and trustful, and
place greater confidence in the assurances of the surgeon ;
that they are more tolerant to confinement to bed, because
they are not accustomed to active outdoor life; and finally,
they are more temperate and regidar in their lives, and not
as frequently the victim of excesses in food and drink.

On the other hand, menstruation, pregnancy, lactation and
the phenomena of the menopause give to the sex the possi-
bility of complications to which the male is not subject. As
a rule operations should be avoided during menstruation, as
the period is frequently attended with nervous and digestive
disturbances. The time of election, especially in gynecologi-

496 FIFTY-FIFTH ANNUAL, SESSION

cal work, is the two weeks midway between the completion
of one period and beginning of the next. In emergencies,
however, an operation may be done during menstruation with-
out misgivings, as usually no ill effects result.

It is also undesirable to do an operation during pregnancy,
as it entails the possibility of miscarriage. The danger is
more theoretical than real, however, as hundreds of abdominal
sections have been done on pregnant women for ai)pendicitis
or other abdominal diseases without interference with gesta-
tion.

It is also inadvisable to operate during lactation, because
the woman's strength and resistance are below par ; and if she
continues to nurse the child she will have an undue tax upon
her, while if she ceases to do so there will be the danger of
trouble with her breast.

Race. The influence of race on the result of an operation
is a question of interest, but not of great practical value. It
is stated that a Chinaman makes the best patient on earth.
In America, especially in the Southern States, there is good
opportunity to contrast the respective resistance of the Cau-
casian and the negro. Surgeons of large experience in ope-
rating on both races are practically unnnimous in the opinion
that the black man is a better subject than the white man.
This does not apply to the mulatto, for he follows the rule of
the mongrel, and has the vices of both parents and the virtues
of neither. It is obvious, even in the life of an individual,
that the pure negi'O is losing the immunity formerlj^ enjoyed
to certain diseases, and is developing predispositions which
render him a less favorable subject for operation. Before the
Civil War insanity was unknown in the race ; tuberculosis
was not common, and venereal diseases of rare occurrence.
With civilization, education and syphilization he is now the
victim of various nervous disorders ; with unhygienic sur-
roundings and scant clothing he is a frequent victim of the
great white plague ; and with improper food, eaten at irregu-
lar intervals ; his digestion has become impaired, and he is

N. C. MEDICAL, SOCIETY. 497

suffering more and more frequently from gall-stones, appendi-
citis and diseases of the kidneys. The day will come wlien
the degeneration of the whole race will have reached a point
to make it an accepted fact that they are poor subjects for
surgical work.

Vigor and WeaJcness. Paradoxical as it may sound, the
strong, robust man frequently does not make as good a surgical
patient as one who is feeble and wasted by disease. He may
have huge limbs and mighty strength ; he may never have had
an illness in his life, and boast of the constitution of an ox,
but he is a poor subject for the surgeon's knife. He is ac-
customed to fresh air and an active life; his blood vessels
are full and oxygenation of the tissues is rapid. His food
has been large in quantity and gross in quality. When mis-
fortune overtakes him there is no time to accommodate him-
self to new conditions, and the whole habit of his life is sud-
denly changed. To this is added the shock of his accident,
the horror of an operation and the dread of the future. Just
the contrary is true with the chronic invalid who has been
acclimated to bed-life by long weeks of invalidism, whose
circulation, respiration and digestion have become adjusted
to his condition, and who has been brought to view the ap-
proaching operation as a means of relief of pain and restora-
tion to health. Of the two types described the latter will be
well first.

Obesity. As a rule a fat patient is a bad patient. If the
obesity is hereditary and the general health good, it is not as
bad as when the fat is due to gluttony, indolence or beer-
drinking. An obese patient is an elephant on your hands.
He usually breathes with difficulty and can not assume a re-
cumbent position. It is hard to move him in bed and difficult
to prevent the formation of bed-sores. The skin is usually
thin from pressure, and its edges difficult to approximate. The
subcutaneous fat has little vitality and readily breaks down
and liquifies. Infection once taking place, pus burrows far

498 FIFTY-FIFTH ANNUAL SESSION

and wide, and is drained with great difficulty. Sometimes
such patients die suddenly from fat embolism ; again they be-
come exhausted and prove an easy victim to intercurrent dis-
eases. If recovery takes place, convalescence is always tedious
and prolonged.

Alcoholism. The most unpromising patient who ever
comes to a surgeon is the chronic alcoholic. Constant drink-
ers who are never drunk, and yet who are never sober, are
worse subjects than those who get on periodic sprees. The
gravity of the risk in the individual case will depend on the
length of time the individual has taken stimulant; the aver-
age amount consumed daily; the presence or absence of tre-
mor of the hand or alteration of the knee-jerk ; the existence
of gastritis, as indicated by anorexia, nausea or vomiting;
and the condition of the liver, kidneys, heart and blood ves-
sels. No operation except the most imperative should be done
on the alcoholic, because of the danger of the administration
of the anesthetic, because of the depraved condition of the
tissues and consequent lack of resistance to infection, because
of the liability of the kidneys to stall or the heart to run away,
and because of the danger of the development of wild and un-
controllable delirium. When an operation is unavoidable,
but not immediately necessary, the patient should be prepared
for it by cutting down or withdrawing the stimulant. When
an immediate operation is necessary it is better to continue
the alcohol until the period of greatest danger is past.

Affections of the Nervous System. Hysterical patients
usually give a great deal of trouble before the operation, but
do very well after the ordeal is over. A nervous woman who
wishes to tell of the unfortunate surgical experience of her
friends, who desires to discuss every step and detail of her
own operation and tell how she wishes her case managed, and
who is possessed of exaggerated fears as to the complications
which may develop or the ultimate result which may follow,
usually, after the operation, becomes a model patient. Her
imagination enters upon fresh fields and she becomes hopeful

N. C. MEDICAL SOCIETY. 499

and courageous, and at once begins to plan a new life of ac-
tivity.

The neurasthenic, however, is a different proposition, and
woe betide the incautious surgeon who operates on one. Oc-
casionally neurasthenia may be due to chronic appendicitis,
uterine displacement or some other cause which can be cor-
rected, and the patient cured. But in a large majority of
cases the neurasthenia is due to a disturbance of the general
body nutrition, and no operation will prove of benefit. The
victim of neurasthenia wears out the patience of his family
and friends, and in order to secure a sympathetic listener,
and in order to demonstrate to the community the serious
nature of his disease, he goes from surgeon to surgeon and
from hospital to hospital, offering himself as a bloody sacri-
fice to his curious form of egotism and glorying in his martyr-
dom. Surgery does this class of patients no good, but simply
deepens rather than relieves the neurasthenia.

The insane are usually good subjects for surgical operation.
The regular life of an asylum is conducive to good health,
and the absence of mental anxiety on the part of the patient
is a favorable factor. Mayo, who has done a great deal of
work on this class of cases, states that they are entitled to just
the same surgical treatment as the sane; no more, no less.
In other words, insane people should be operated on to relieve
them of hernia, gall-stones and abdominal tumors ; but hernia,
gall-stones and abdominal tumors should not be operated on
to cure the patient of insanity.

CoNSTITUTIOlSrAI. DISEASES.

Rickets is a condition of bony malnutrition. If the gen-
eral health is good, wounds heal as well in rickety subjects as
in other cases.

Syphilis does not usually increase the risk of a surgical
operation. Wounds made during the full bloom and blossom
of the secondary stage heal kindly, and operations done on
tertiary lesions usually do well. The danger in operating in

500 riFTY-FIFTH ANNUAL SESSION

the early stages of syphilis is rather one to the surgeon than
to the patient, as the blood is infectious.

Gout has no effect upon the result of an operation, unless
it has existed sufficiently long to produce cardiac or renal
changes. It is, of course, not wise to operate during an acute
attack of the disease, and it must also be remembered that an
operation sometimes precipitates an attack in a person pre-
disposed to the disease.

Hemophilia contra-indicates a surgical operation, unless
urgent and required to save life. Fortunately the subjects
of hemophilia do not always bleed. A case is in mind where
a man was brought to the hospital with gangrenous appendi-
citis, who gave a history of having suffered repeatedly from
almost fatal hemorrhage after trivial injuries. After con-
sultation, a section was determined on, and was performed
with less than the usual loss of blood.

Malaria and an injury or operation have a reciprocal rela-
tion one with the other. Malaria may cause pain, hemor-
rhage or inflammatory changes at the site of injury, which
assume an intermittent type and yield to administration of
quinine. Again, an injury or operation inflicted on a person
the victim of malaria may markedly aggravate the disease, or
induce a fresh onset of ague; or again, it will make active
symptoms in a person who is not known to be infected.

Diabetes is an almost positive contra-indication to an opera-
tion, as the tissues of a diabetic patient possess little power of
regeneration, and have so little resistance to infection that in-
flammation, suppuration and gangrene are almost certain to
develop. Surgery on diabetics should only be done when
most imperatively demanded, as often when the sugar in the
urine has been decreased to an insignificant amount by weeks
of dietetic treatment, it will reappear in large quantities im-
mediately after the operation, and the patient die in diabetic
coma.

n. c. medical society. 501

Visceral Disokdees — Cardiac and Valvular Diseases.

Valvular disease of the heart is believed by the laity and
by most of the profession to add greatly to the risk of the
anesthetic and to the danger of death from complications fol-
lowing the operation. This does not seem substantiated by
facts, as but a small proportion of the patients who die from
chloroform or ether are found to have been the victim of
organic heart disease, and as far as convalescence after the
operation goes, patients with heart trouble are usually mark-
edly improved by the enforced rest and confinement to bed.
A dilated or fatty heart is much more to be feared than one
with valvular lesion, especially if there be adequate com-
pensation.

Atheroma of the arteries was formerly thought to predis-
pose to secondary hemorrhage, but in modern practice this
complication is rarely, if ever, seen. The complication to be
most dreaded from disease of the arteries is gangrene, due to
lack of nutrition of the tissues to w'hich they are distributed.

Renal Diseases.

It was formerly thought that the presence of albumin or
casts in the urine indicated grave organic change in the kid-
ney, and was a bar to surgery. This ji-aj have been the case
with the crude tests of the older pathologists, but it is cei'-
tainly not so to-day, for the modern laboratory man finds
albumin and casts in practically every specimen submitted to
him. Dr. Osier has emphasized this in a recent article en-
titled, "'The Advantages of Having a Few Casts in the Urine
After a Man Reaches Sixty Years of Age." Certain forms
of nephritis, however, add greatly to the danger of an opera-
tion, and all surgeons occasionally lose patients from su]d-
pression of urine, followed by ura^mic convulsions. No opera-
tion of election should be done on a patient suffering with
advanced Bright's disease, and when the urgency of the case
is such that an operation has to be done, the patient should be
carefully prepared by dietetic and eliminative treatment

502 FIFTY-FIFTH ANNUAL SESSION

before the operation, and the kidneys kept active afterwards
by the use of spartein and the administration of large quanti-
ties of water by mouth or rectum.

Respiratory Tract.

Bronchitis, pneumonitis and phthisis pulmonalis are serious
bars to surgery, inasmuch as they make the administration
of the anesthetic difficult and dangerous, and complicate the
after-treatment by coughing, embarrassed breathing and im-
perfect oxygenation. In acute inflammation of the lungs,
operations should be postponed, and in chronic trouble, they
should not be done except to meet most urgent indications.

Alimentary Tract.

Gastric dyspepsia, intestinal indigestion, diarrhoea and con-
stipation are all conditions to be corrected prior to an opera-
tion. The progTiosis is bad when to the toxins of disease is
added the poison produced by putrefaction of gastric and in-
testinal contents. In correcting the conditions named, food
should be sterilized, the mouth should be repeatedly disin-
fected, the stomach should be washed out, and intestinal anti-
septics, together with purgatives, should be judiciously ad-
ministered.

In diseases of the liver, especially when the patient is jaun-
diced, the danger of hemorrhage should be determined by
testing the coagulability of the blood, and, except in cases of
greatest urgency, operations should be postponed until the
cholemia subsides or until, by the administration of calcium
chloride or other drug, the danger of uncontrollable bleeding
be removed.

Diseases of the Blood.

Anaemia, or a deficiency of either hemoglobin or red blood
cells, is often a contra-indication to an operation. Mikulicz
states that a hemoglobin percentage below thirty, or a red
blood coinit below 3,500,000 should postpone operative inter-
vention until tlie blood is enriched by medical treatment.

N. C. MEDICAL SOCIETY. 503

While this is a safe rule to follow, it has its exceptions. The
lives of two women have recently been saved, whose hlood
findings were below this minimum owing to profuse and un-
controllable uterine hemorrhage, by the operation of hysterec-
tomy.

Leucoeytosis, or increase in the polymorphonuclear leuco-
cytes, especially when progressive, indicates advancing suppu-
ration and demands early operation.

Leucocythemia, or an excess of mononuclear leucocytes,
contra-indicates all operations, as the patients invariably die
after removal of the spleen, and stand in great peril after
more trivial procedures from hemorrhage, infection and other
complications.

504 FIFTY-FIFTH ANNUAL SESSION

A PLEA FOR EARLY OPERATION" IN APPENDI-
CITIS WHERE THE DIAGNOSIS IS OBSCURE.

BY J. F. HIGHSMITH, M.D.,

Surgeon in Chief, Highsmitti Hospital, Fayetteville, N. C.

All will admit the importance of operating early in typical
cases of appendicitis. No one will contend that it would be
wise to delay in typical cases. But the class of case which
I hope to bring before your minds now are those where the
surgery is obscure, we underrate the gravity of the case and
our mistakes prove fatal.

This is a subject which has been discussed pro and con
for several years past, but is one that never groAvs old to the
abdominal surgeon. At the present time to open the abdom-
inal cavity with proper surroundings is free from danger.
The dangers arising from the conditions found of the inter-
nal organs and their subsequent treatment, and not from the
exploratory incision. Not to explore is to remain in abso-
lute ignorance of the true conditions that exist within the
abdominal cavity. Not knowing it is absolutely impossible
to give our patient that scientific treatment or that common-
sense treatment which is so simple once the true nature and
cause of the existing disease has been accurately diagnosed —
the old adage ever holding true: "He who diagnoses well,
cures well."

As I have previously stated, all admit the importance of
operating early when the diagnosis is clear, and the impor-
tance of applying surgery as the remedy in these cases. I am
glad we can say this tendency to operate early has wonder-
fully advanced in the last few years. Until recently appendi-
citis was divided into medical cases and surgical, while to-day
it is looked on by the greater majority of the profession as
being a surgical disease, and the sooner the remedy is intel-
ligently applied the better. The average general practitioner
has no hesitancy in recommending an appendectomy where

N. C. MEDICAL SOCIETY. 505

the diagnosis is clear, but where the diagnosis is obscure he
many times postpones until it is too late, and that awful
enemy, "infection," has established itself and we are at its
mercy to do the best we can for our patient.

I could not go without saying the same holds true in gall-
bladder surgery, peritoneal tuberculosis, intestinal perfora-
tion in typhoid, surgery of the stomach and pancreas. For
in these as in all other surgical diseases of the internal vis-
cera, a favorable mortality is established by early diagnosis
and prompt surgery. And to diagnose accurately the key-
note is EXPLORATIOlSr. Exploration rendered harmless
by our co-laborers in the past. We can but rejoice in the be-
half of surgery as a science which had made no profound im-
pression upon the world until about a century ago. Such
men as Morton, Simpson, Lister, Simms, Gross, and many
others too numerous to mention, must not be forgotten. From
such mighty leaders we can but reap full sheaves to reward
us in the battle which we are continuing for suffering hu-
manity and against disease.

The possibility of abdominal surgery rendered safe by
antiseptics and improved technique to relieve many obscure
cases of intra-abdominal disease ranks foremost to-day. This
all admit, but at the same time we must urge that delay is
dangerous ; "a stitch in time saves nine."

It is a common practice of text-books to describe a pre-
vailing type or typical form of the disease, and if a case al-
ways followed the type described in the text-book then mis-
takes would seldom be made; diagnosis would be a matter
of no difficulty. Typical cases are common, it is true, but
atypical cases are also common. This is especially true in
appendicitis. The masked cases of appendicitis are many
times the dangerous cases. For especially in this class of
cases the attending physician is not sure of his diagnosis
and hopes that the case may get better on expectant treat-
ment.

It is only necessary to call to our minds the results of un-

506 FIFTY-FIFTH ANNUAL SESSION

recognized cases such as appendiceal abscesses, gangrenous
appendix, diffuse peritonitis and metastatic infection, to real-
ize that too high a price has been paid for delay in operating.

Very few practitioners will fail to advise operating in
cases accompanied by violent pain about McBurney's point,
rigidity of right rectus, persistent vomiting and fever. But
many times it is more dangerous to wait in certain cases in
which the physician thinks he is dealing with a very mild
type of the disease, if it exists at all. These doubtful cases
are dangerous. Yes, with a temperature of 99 and pulse 80
the condition may be alarming. As examples I briefly cite
a few cases from 200 appendectomies performed for differ-
ent types of the disease.

First, I cite a case where the subjective symptoms were
mild, the pulse and temperature were both low. Mr. A
came to my office complaining of pain in right side of abdo-
men. He had been suffering from constipation and indiges-
tion for some time. There was no marked spasm of the mus-
cles, no increasing temperature, no exhilarated pulse. This
patient was given repeated doses of Epsom salts until the
bowels were freely moved. The second day the patient was
in bed. The bowels had moved freely, but still there was no
rigidity, but slight tenderness and with a temperature of
99 1-2. 'No food was given by the stomach, the patient was
kept absolutely quiet in bed awaiting developments. On the
evening of the second day the patient had a chill with a
temperature of 103 following. An operation was at once
advised. It revealed a gangrenous appendix, which was re-
moved without being ruptured. The case drained for twenty-
four hours and made an uneventful recovery.

The second case was that of a mill man. On January
14th he was well and attending to his duties. At 11 o'clock
a. m. he had a pain in his abdomen; at 12 o'clock he had a
slight headache. His bowels moved and the pain disap-
peared. Pressure over the region of the appendix caused
nausea. On his own account he took a dose of salts at 2 p. m.

N. C. MEDICAL SOCIETY. 507

and went to bed and sent for his physician. There was no
rigidity of the rectus. The physician called detected no
symptoms of appendicitis, but thought as soon as his bowels
had moved that this abdominal pain would disappear. At 8
o'clock p. m. his temperature was 98 6-10 and the pulse 100.
On the morning of the 16th at 11 o'clock his bowels had
moved well from the salts, his pulse was 115 and his temper-
ature 99 ; slight rigidity with some pain in the ileocecal re-
gion. Six months prior to this the patient had had a similar
attack which was diagnosed appendicitis. With this history
on the evening of the second day, twenty-four to thirty-six
hours from the first symptom, an operation was advised and
revealed an appendix perforated at the tip with pus in the
peritoneal cavity. This patient was kept in the Fowler posi-
tion, drained, and, after being extremely sick, recovered.

The third case was that of a drug store clerk, who was
seen about two Aveeks after he had returned from a camping
expedition. He was complaining from digestive disturb-
ances, which you would think but natural. At 3 o'clock that
afternoon he complained of general abdominal pain, but was
not severe. The pulse was 90 and the temperature 99, for
as long as he remained quiet there was no pain, but if he
moved himself he suffered considerably. On the morning of
the second day his temperature was 100 and pulse 100, with
a very slight rigidity and some tenderness over the appendi-
ceal region. Operation revealed an inflamed appendix with
a gangrenous tip.

Another case similar: My own son, a schoolboy, age six-
teen, for some weeks previous had been complaining of indi-
gestion, general lassitude, eyes giving him trouble, and it
was with difficulty he could apply himself to his studies, be-
coming tired so easily. Saturday he was bright as usual,
playing around home, and was indiscreet as to his diet. Sun-
day morning he remained home, did not go to Sunday School,
complaining of cramplike pains all through his abdomen.
Thinking this was due to the cocoanut candy he had eaten

508 FIFTY-FIFTH ANNUAL SESSION

the day before, I directed him to take a dose of Epsom salts,
this to be repeated every two hours until bowels moved
freely, thinking but lightly of his condition. The salts acted
well, but Sunday night he did not rest but complained of
nausea off and on during the night. Monday morning he
was suffering no pain, but would have occasional vomiting
spells, and I thought I could detect a very slight rigidity over
the region of the appendix, and he would be nauseated after
pressure over the appendix.

When he was eight years old he had what I thought was a
mild attack of appendicitis. I might state that up to this
time he had had no fever and no marked increase in the pulse
rate. But with his previous history I was suspicious of ap-
pendicitis. At 2 o'clock p. m. on Monday his temperature
was 99 and pulse 100 ; pain had increased all over his bowels,
but more marked over the appendix. At 8 o'clock in the
afternoon temperature 100, pulse 110. At 10 p. m. he had
a marked chill and his temperature jumped to 104. I ope-
rated at once. I found a large gangrenous appendix, giving
the appearance of a bologna sausage at the tip, just ready to
rupture. This was removed without rupturing, and drained
for forty-eight hours. He was very sick for four days, hav-
ing great trouble to get his bowels to move, but after this had
a rapid recovery. Since then he has gained in strength and
is now a strong boy.

The fifth case, Mr. S, a merchant. Two weeks before }]e
consulted me he was in bed and under the care of his physi-
cian for three days when he, to all appearances, Avas quite
himself again. ISTo fever, and but for a slight soreness and
a feeling of weight in his right side claimed he was all right.
His temperature was normal, also his pulse. His bowels
moved well. Gave a history of having had similar attacks
before with loss of weight, bad digestion, etc. ' An operation
revealed a highly inflamed appendix about which there was
an ounce or more of pus.

A few days later another case, a farmer, came under my

N. C. MEDICAL, SOCIETY. 509

care, suffering identically the same; and on operation the
same conditions were found. And following this was a third
case of the same type. These cases were all drained and all
recovered. Abscesses had walled themselves off, the patients
had no fever and to all appearances, except some soreness in
the region of McBurney's point, all symptoms were negative.

Still another case, a merchant, age 30, was referred to irie.
Gave a history of having had several attacks of appendicitis,
as they thought. When he would have attacks a mass would
form in his side then would disappear. This patient, a very
intelligent man, claimed the pus from this abscess ruptured
into his bowels. He was sent to me about the time he was
getting over one of these attacks. He had no fever, very lit-
tle tenderness in his right side, bowels regular, but showed
from his general expression a state of sepsis and that he was
suffering. I kept him under watch for a few days and he
consented to an operation. The operation revealed the fact
that he had a large abscess of the appendix, the appendix
dilated, and when this had gone its limit in some way it rup-
tured back into the head of the csecum, and in that way
drained the abscess cavity. When there was any interference
with this drainage chilly sensations would come on and he
would have all symptoms of a general septic condition, due to
something he knew not what. This condition had been due to
an appendiceal abscess which had been drained into the
caicum, thereby saving the patient's life. This patient re-
covered after the operation.

Another patient, a young schoolgirl eighteen years old, had
certain articles of food to disagree with her for some time
and had to be careful about her diet. Pain and tenderness
were not extreme nor were they felt in any one spot. This
type of case is the most frequent one of masked appendicitis.

This class of cases are the ones that furnish the mortality
from appendicitis. 'No one can tell of the real condition of
the appendix except from inspection, and a great per cent of
the cases that we do operate on are pus or gangrenous. I

510 FIFTY-FIFTH ANNUAL SESSION

would urge in cases of this kind to be on the safe side and
operate within twelve hours from the beginning of an attack.

From these cases which I have reported with no deaths it
would seem that all my cases get well. Let me correct this
impression and say that with this type of case in early opera-
tion I have been very fortunate and have lost no case, but
when my cases had gone into general sepsis, ruptured appen-
dix, bowel paresis and general peritonitis I have lost my
share.

What I have said is nothing new. It is an old story to us
all, but I hope that it may impress some one as I, myself, have
been impressed with the obscure and treacherous disease, and
thereby save some life which would otherwise have been lost.

N. C. MEDICAL SOCIETY. 511

A FEW RECEIPT UNIQUE SUEGICAL CASES.

BY JOSEPH GRAHAM, M.D.,
Surgeon Watts Hospital, Durham, N. C.

Not having the necessary time to prepare a paper on a
surgical subject, and wishing to show my interest in the So-
ciety, I decided to present a few unusual cases that have oc-
curred in my practice since the last meeting:

Case No. 1. — Excision of three feet of the ileum and all
of the caecum and ascending colon.

Fay W., aged eleven years. Patient of Dr. E. A. Aber-
nethy. Admitted to Watts Hospital May, 1908. Diagmosis,
appendiceal abscess. After a thorough examination I agreed
in the diagnosis.

History. — Four days previously sudden pain in abdomen
followed by nausea and vomiting. Pain localized over ap-
pendix area. Marked localized tenderness and rigidity. Lo-
calized area of dullness on percussion. Rectal examination
detected a mass in ileocascal region. Temperature 102 2-5.
Pulse 130.

Previous History. — Had four attacks of colic in past two
and one-half years. The last two had been followed by nausea
and vomiting, localized soreness and confined him to bed for
a few days.

Operation. — Incision one and one-half inches through
right rectus. Examining finger detected the appendix. This
was elevated and removed. Examination showed acute in-
flammation but no pus. Then examined to ascertain the
cause of the mass we had detected. Found a growth involv-
ing the cfficum and ileum. Therefore I enlarged the short
incision into an eight-inch incision. Examination showed a
growth in the ileum, caecum and ascending colon, with marked
enlargement of the ileocsecal glands. Some of these glands
were as large as hickory nuts. We decided that it was pos-
sible to remove the growth and performed a resection of ileum,
caecum and all of ascendins; colon. ' The wide involvement

612 FIFTT-FIFTH ANNUAL, SESSION

of the mesenteric glands required removal of so mncli mesen-
tery that it was necessary to resect an additional foot of the
ilemn so as to secure healthy bowel for the anastomoses.
There was no escaj)e of fiecal matter, rubber-covered clamps
being used for coprostasis. The bowel reeds were inverted
and a lateral anastomosis by needle and thread was made
between lower end of ileum and transverse colon. The total
length of removed bowel measured four feet, four inches.
Tearing some local infection I drained area of anastomoses
by a cigarete drain. Inserted a glass drain to bottom of pel-
vis, and on account of shock filled the lower abdomen with
salt solution. The Avound was closed by continuous catgut
suture of peritoneum and interrupted A. W. G. sutures. The
patient was placed in the exaggerated Fowler position. His
convalescence has been without incident. Examination of the
removed strictures shows a tumor involvement of the ileum,
caecum and ascending colon. The enlarged ileocffical glands
contained pus. There were no tubercles on the surface of the
peritoneum, and no ulcers were found in the bowel. The
specimen was sent to a pathologist, and we will have his re-
port at an early date. For successful issue in this case I am
deeply indebted to Drs. C. A. Hicks, R. L. Felts and C. A.
Woodard who gave me very able assistance.

Case No. 2. — Gangrenous kidney; trans-peritoneal ne-
phrectomy. Recovery. Report of Dr. E. A. Abernethy.

Ula L., thirteen years old. Birth normal. Childhood with-
out special incident. ISTo disease bearing on condition under
consideration.

Present History. — About one year ago patient was brought
to me suffering with what I thought to be the beginning of
menstruation. Complained of headaches, backaches and in-
definitely located pains in the "stomach." These "spells"
came on at periods about four weeks apart and lasted several
days. Since the present conditions have developed the mother
says there were pains that might have been referrrd to the
kidneys. I do not remember anything that led me to suspect

N. C. MEDICAL SOCIETY. 513

kidney involvement. As the child was well developed and
approaching the age when menstruation should begin I diag-
nosticated the trouble as an effort to establish this function.
Iron, arsenic, and manganese, together with proper hygienic
measures were prescribed. This treatment was continued
over a period of months, and the menstrual function with
some irregTilarities was established, and I lost sight of the
patient.

On June 3, 1907, was called to see her. Learned that four
days before while in apparent good health she had, when aris-
ing in the morning, complained of pain in right side of abdo-
men just above crest of ileum. This pain had become worse
and had gradually extended over most of right abdominal
region.

On examination. — Patient lying on back with right thigh
flexed, expression indicating severe period. Temperature
101, pulse about 140, running, and of poor volume. Muscles
on right side of abdomen rigid ; entire right side of abdomen
tender, with marked tenderness over McBurney's point. An
area of dullness around region of appendix several inches
across. Bowels had been thoroughly moved before I saw pa-
tient. Kidneys, as far as I could learn, were doing their work
normally. ISTo examination of urine was made.

A diagnosis of acute appendicitis with rupture was made,
and owing to the apparent desperate condition of the patient
she was immediately sent to the Watts Hospital at Durham,
a distance of twenty miles, where she was placed in the care
of Dr. Joseph Graham.

On July 13th the patient was returned to my care, and at
this writing, July 30, 1907, her wounds have so nicely pro-
gressed that her mother is now dressing them. The patient
is in better health than she has enjoyed in the past year, eat-
ing what she wants, going w^here she pleases, suffering no pain
and apparently not inconvenienced by the loss of her right
kidney.

514 FIFTY-FIFTH ANNUAL SESSION

Condition on admission to Watts Hospital. — A well-
developed girl, aged thirteen, Ula L. Facial expression
shows great pain.

History. — Four days before developed sudden pain in
right iliac fossa near umbilicus. Pain gradually grew worse
and was followed by nausea and vomiting. Pain was local-
ized in right iliac region. Pain was much relieved during
night of second day, but returned on the third day and was
more severe and continuous, followed by return of nausea
and vomiting. Vomiting was repeated after admission to
the hospital. 'No movement of the bowels for two days.
Purgatives had been repeatedly administered by the family
before calling Dr. Abernethy. ^Nothing could be elicited as
to previous history, as patient was suffering extremely and
father knew little of her history.

Examination. — Temperature 104, pulse 146, respiratiiui
26-30. Patient located pain directly over McBurney's point.
Palpation reveals marked rigidity of entire right side of ab-
domen and some slight general tenderness, more pronounced
over McBurney's point. No tenderness in lumbar region or
over gall bladder. Percussion revealed an area of dullness
in right iliac. No irritability of bladder ; specimen of urine
obtained by catheter revealed normal sp. gr. and no albumin.
Leucocyte count was not made. Rectal examination revealed
tenderness in right iliac.

Diagnosis. — Appendicitis, perforation, abscess.

Operation. — Right rectus (Deaver) incision.

On opening abdomen found omentum adherent in riaht
iliac fossa to colon and parietal peritoneum. Working care-
fully through a coffer dam of gauze a perfectly normal aiv
pendix was found and removed; then sought for the trouble
causing adhesions.

Pelvic organs normal. Right kidney could not be found ;
carried finger up and palpated gall bladder, which was ap-
parently normal. As finger came away from gall bladder a
hard, slightly movable mass was detected. Enlarged incision

N. C. MEDICAL SOCIETY. 515

and separated omentum from colon, jjacked colon to inner
side of wound. Then found a hard mass behind the messe-
colon, the shape of the kidney, but approximately twice as
large. Carefully protecting the abdominal contents ^^^th
gauze diaphragms, an incision was made through the outer
edge of messe-colon. A black, enlarged kidney came into
view. Deciding to do a nephrectomy, we elevated the kidney
and found the pelvis of the kidney and upper end of ureter
to be distended with fluid. Expecting pus, carefully pro-
tected and then ligated pedicle and clamped between kidney
and ligature. Then cut between clamp and ligature, dropping
the ligated stump of pedicle and lifting out the kidney. As
the pedicle dropped back it bled profusely. The ligature
had cut the pedicle. Retied the artery and hemorrhage was
completely controlled. There was a twist in the ureter a few
inches below ligature, but no calculus. Then packed the
cavity with gauze, Avhich was covered over with the messe-
colon, and the incision in messe-colon sutured with catgut.
Removed gauze protectives, adjusted intestines and closed ab-
domen without drainage. Then made incision in lumbar re-
gion and brought out end of gauze which had been previously
packed in cavity for drainage. Patient was considerably
shocked, but promptly rallied.

Examination of removed kidney revealed a very much en-
larged organ, very black in color. Incision revealed no pus
or stone. The kidney was friable and could be broken and
torn with the fingers by very slight effort.

Post-operative history. — ^With the exception of slight mural
abscess recovery was uneventful. The girl soon rallied from
the shock. Temperature and pulse returned to normal. iSTo
nausea, vomiting or obstructive symptoms. Daily examina-
tion of urine showed quantity above the average, compar-
atively low sp. gr., and at no time did examination reveal
albumin, blood or casts. She had no lieadache and no dis-
turbance of vision.

l^ovember 1, 1907. The patient is apparently in perfect
health.

616 FIFTY-FIFTH ANNUAL SESSION

For successful issue in this case I am very much indebted
to Dr. C. A. Adams, who gave very able assistance, and to
Dr. Will Holt, who administered the ether so successfully
that we were able to finish this long, tedious operation with a
living patient, although she went on the table in a desperate
condition.

Case No. 3. — Ovarian cyst; twisted pedicle; gangrene rup-
ture. Recovery.

Ella M., age thirty-two. Single. Patient of Dr. C. A.
Adams.

History. — Few days previously seized with sudden pain
in right side of lower abdomen, followed by nausea, vomiting,
distention and obstipation.

Examination. — Marked distention of the abdomen. Pal-
pation, marked rigidity, especially over lower abdomen; per-
cussion, dullness over lower abdomen corresponding to a six
months pregnancy. Vaginal examination, patient menstru-
ating ; cervix not enlarged ; uterus seems to go backward to-
ward rectum; bimanual examination detects elastic fluctu-
ation; rectal examination detects the retroverted uterus and
the finger can be carried above fundus and bimanual exami-
nation gives definite elastic fluctuation.

Diagnosis. — Ovarian cyst, twisted on its pedicle.

Immediate operation advised and declined. Thirty-six
hours later I learned that patient had grown much worse,
was on way to hospital and desired immediate operation.
Examination on admission to hospital revealed an enormously
distended abdomen with planklike rigidity, continuous vom-
iting and complete obstipation. Temperature 103 2-5, and
pulse 160. I washed out stomach and prepared for operation.
On opening abdomen through a twelve-inch incision I found
an ovarian cyst, the pedicle twisted three times over; the
walls of the cyst had become gangi-enous and ruptured. We
ligated pedicle, excised cyst, and then removed a portion of
the cy-itic fluid. A glass tube was inserted to bottom of pelvis
and ;he abdomen closed. The patient was placed in the ex-

N. C. MEDICAL SOCIETY. 517

aggerated Fowler position and received the continuous low
pressure IsT. S. enema.

Convalescence was without incident.

I am indebted to Dr. C. A. Adams for referring this inter-
esting case and for very able assistance in the operation.

Case No. 12. — Left-sided appendicitis; acute diffuse sup-
purative peritonitis.

Willie F., age twelve. Patient of Dr. R. E. ]^ichols.

History. — Four days previously seized with pain in abdo-
men, followed by nausea and vomiting; pain was localized
over left iliac region two inches below and two inches to the
left of navel. As his condition grew worse I was called by Dr.
Nichols to operate at the patient's home. Examination re-
vealed extreme distention of the abdomen with marked rigid-
ity. There was general tenderness, more marked on the left
side at a point corresponding to the McBurney point. Rectal
examination did not reveal any tumor. The child was ex-
tremely ill; temperature 102 1-2 and pulse 160. Vomiting,
and no result from enemata. We made a diagnosis of acute
peritonitis and probably left-sided appendicitis. The opera-
tion was performed outdoors under the trees. I opened the
abdomen in the median line and a large quantity of pus es-
caped. There were a few adhesions but no real abscess wall.
The appendix was found extended obliquely directly across
the abdomen. It was abnormally long, being attached to the
ligmoid flexure. The appendix had perforated near the tip.
We removed the appendix, applied a cigarette drain to the ap-
pendix area and a long glass tube to the bottom of the pelvis.
The patient was placed in the exaggerated Fowler position
and received the continuous low pressure H. S. enema. Al-
though desperately ill the patient made an uninterrupted
operative recovery and is now in hospital.

I am deeply indebted to Dr. R. E. I^ichols and Dr. C. A.
Hicks for very efficient aid in operating on this case.

Case No. 6. — Depressed fracture of skull and rupture of
meningeal artery.

518 FIFTY-FIFTH ANNUAL SESSION

Negro boy, "Bumpie," age 14. Patient of Drs. Moore,
Shepard and Warren,

I was called in consultation to Lincoln Hospital.

History. — Four hours previously the boy was struck by a
hickory stick over left eye and had fallen unconscious. Con-
sciousness had not returned. There was a ragged wound one
and one-half inches through skin over the left eye and extend-
ing into nose. Everything being in readiness I began imme-
diate operation. I turned down a flap about three and one-
half inches wide. I found a depressed fracture of the frontal
bone, which extended into orbit and nasal cavity. Plugging
this nasal wound I examined the depression and removed a
depressed piece of bone three-fourths by one-fourth. Exam-
ining the inner table I found it punctui^d. On further ex-
amination I detected and removed five splinters of bone from
the left frontal bone. Suspecting a possible lesion of the
meningeal artery, I passed in a small curette and removed a
little clotted blood, which was followed up by a profuse flow of
bright red blood. I immediately opened skull, found bleeding
vessel and ligated it. The wound was drained by a strip of
rubber tissue and closed. Convalescence was without special
incident. The boy has no disturbance of sight or smell, no
headache and no nervous symptoms. His recovery is perfect.

N. C. MEDICAL SOCIETY. 519

SOME PRACTICAL POmTS IN THE MANAGE-
MEA^T OF INGUINAL HERNIA.

BY K. L. PAYNE, M.D., NORFOLK, VA.,

Honorary Member X. C. Med. Society, Gynecologist St. Vincent's Hospital, Norfolk, Va.

The most common of all accidents which befall humanity
is some form of hernia.

About one in every twenty or thirty people born are at some
period of life so affected. Sex seems to exercise a controlling
influence and we find in men about one in 14.9 have some
form of hernia, w^hile in women the proportion is thought to
be one in 44.7 persons. Of the whole number afflicted with
hernia about eighty-four in every hundred suffer from in-
guinal hernia, and at least one-seventh of all cases of inguinal
hernia, seen for the first time, are in children under one year
of age. Indeed, the majority of cases of hernia occur before
middle age, and the largest number during the first ten years
of life (Kingdon).

This is almost entirely due to the persistence of the pro-
cessus vaginalis. Francke tells us that in his operations for
oblique ingiiinal hernia he found a congenital sac in 28.6 per
cent of his cases ; Beresowsky found congenital sac in 35 per
cent; and Wood, operating on 370 cases of inguinal hernia,
found congenital sac in 33.3 per cent. Later writers make
the percentage larger still. Add to this the nearness together
of the abdominal rings in infancy and the frequent increase
of abdominal pressure due to crying, straining at stool,
straining in micturition due to phimosis, and it is easy to see
why inguinal hernia is relatively frequent in the very young.
Nature makes every effort to overcome these conditions. The
tendency is always to obliteration of the vaginal process, and
the gradual widening of the pelvis during the continuance of
development brings the abdominal rings wider apart so that
weak points are not so closely opposed. In this way many
times the inguinal hernia of infants is cured, and with these

520 riFTY-FIFTIl AN^VUAL SESSION

natural adjuvants to the treatment a little aid on the part
of the physician will cure most of the hernias of early child-
hood. In my experience, however, very few physicians pay
any very great attention to these cases. Advice to keep the
bowels open and reference to a druggist for a truss is usually
all that is done, and such advice is woefully insufficient. Great
attention must be paid to the nutrition of the child, for the
development of the muscles and even the distribution of fat
contributes toward the cure. Constitpation must be relieved,
and if phimosis be present it must be removed. jSTcxt, tlie
mother must be instructed as to how she can keep the hernia
from coming down, and for this purpose nothing could he
more unsatisfactory than the trusses found in the shops.
Trusses can rarely be made to fit a baby with comfort ; they
can seldom be kept in place, and the hernia frequently coming
down the eifer-ij w' ^bc treatment is lost; they are dirty and
expensive, for if we resort to trusses several must be provided
in order that one may always be ready for use; and by no
means the least objection is that they frequently excoriate the
tender parts and must be abandoned.

What I have used for years to hold the hernia up is the
simple hank of yarn ; and though I am aware there is nothing
new about it, I am sure its usefulness is not as generally
recognized as it should be, and this is my apology for calling
it to your attention. The method of application is simple.
With the infant lying on its back and the hernia reduced
and held in place by the finger, one end of the skein is laid
over the open ring. The free end is now carried to the oppo-
site side and under the back to the point of beginning, where
it is passed through iLf^ loop in the end of the skein already
in place over the ring and then carried down through the
perineum and tied to the skein in the back ; or, what I most
often do, instead of passing through the perineum the skein
is split and tied around the thigh of the same side. This
leaves a loose, soft knot over the ring, and without undue
pressure it may be drawn tight enough to effectually prevent

N. C. MEDICAL SOCIETY. 521

the descent of the hernia. It is necessary to j)rovide several
skeins so that change may be made whenever the child is wet
or soiled. The child must be bathed with the yarn in place,
and when changes are necessary the child must be recumbent
and must not be crying, while the thumb of the nurse is kept
over the ring so that the hernia is never allowed to come
down. The child must be kept dry, and the skin, where pres-
sure is made, well powdered. The treatment must be main-
tained for from six to twelve months, and though at first
glance it looks very troublesome, it is wonderful how quickly
the careful mother will go about it in a routine way ; and after
all it is much less troublesome and expensive than any form
of truss, while in my hands, by its use, cure has been the
rule.

If this method fail, then it is well to try what may be done
with either a spring or elastic truss until the child is cured
or is old enough for the radical operation, for in my opinion
there is never a time while hernia persists that the treatment
may be safely abandoned.

As to the age at which the radical operation may be done
opinion differs. I have operated with success as early as the
fifth month (operated because of strangiilation), but it is
usually best to wait until the child is four or five years old,
both because of the possibility of cure without operation ; and
what is even more important, in very young children, the ope-
ration is more dangerous, and the abdominal muscles are too
poorly developed to make us feel sure of the success of tlie
operation.

This brings up the general question of operation in cases
of hernia, and here, as in the treatment of hernia in infants,
I do not believe our profession is fully measuring up to its
duty in instructing the people as to the possibility of cure
by radical operation. Most people suffering from hernia are
facing a serious proposition. ITot only do they suffer more
or less constant discomfort, but they are excluded from many
appointments in the public service ; they are unfitted for

522 PIFTY-FIFTII ANNUAL SESSION

heavy manual labor, and at all times the menace of strangu-
lated bowel stares them in the face. If they be overtaken by
this complication then the predicament is indeed serious One
of the very best surgeons in this Society told me he had never
had a case of strangulated hernia, on which he was called to
operate, recover. The death rate is 6 per cent when strangu-
lated hernia can be reduced by taxis, and in cases where ope-
ration must be done the most reliable statistics show a death
rate of 19 per cent. On the other hand, the operations for
radical cure have been so perfected that the last report of the
operations of Coley and Bull show a death rate of only 0.5
of 1 per cent, while the percentage of relapses following ope-
ration in 1,978 cases is as low as one-fourth of 1 per cent. In
tlie face of these facts then, when a patient suffering from
hernia seeks advice, I feel sure it is wrong to simply fit him
with a truss and let him go, unless there be some very good
reas ai why operation shall not be advised.

Just a word in passing as to the operation of choice in at-
tempting the radical cure. In my own practice I have aban-
doned all methods except the operations of Bassini and Hal-
stead. In the vast majority of cases the Bassini is the opera-
tion of choice both because of its simplicity and less frequent
unpleasant sequelae. Following the ITalstead operation or-
chitis is common ; atrophy of the testicle not infrequent, and.
in one case in which I was consulted, a permanent and marked
hypertrophy of the testicle resulted, probably due to the too
complete excision of the veins of the cord and consequent in-
terference with the return current of blood. These untoward
results may be guarded against, and in direct inguinal hernia
as well as in cases where the hernial opening is unusually
large and the abdominal muscles poorly developed, I believe
the Halstead operation as modified by Bloodgood offers the
best safeguard against recurrence.

If we have not cured these cases by some form of truss in
childhood or by the radical operation later, every moment
they live they are in danger of strangulation, and we can offrr

N. C. MEDICAL SOCIETY. 523

no absolute safeguard. It is a mistake to believe that the gut
ouly becomes strangulated under violent exertion of some
kind (cite Walser case), for, while this is a predisposing
cause, I am satisfied that under conditions entirely beyond our
control strangulation may and does occur; and this is espe-
cially true if there be j^resent an irreducible hernia. Even
with a well-fitting and, so far as can be made, effective truss,
the gut may at any time slip under the pad and become stran-
gulated. When strangulation does occur we are face to face
with one of the gravest emergencies in surgery. Ninety-five
■per cent of such cases, untreated, die. The symptoms are
usually not to be mistaken. A hernia previously movable
suddenly becomes the seat of pain and is irreducible. It
grows larger and no longer yields an impulse on coughing.
The face of the patient looks anxious and pinched. In many
eases there is a state of shock with colicy pain, nausea and
vomiting, which sooner or later becomes stercoraceous. There
is constipation and the abdomen becomes tympanitic.

If no hernia has previously existed the symptoms detailed
are immediately preceded by the sudden development of a
swelling in one of the usual situations of hernia, and the ex-
istence of such symptoms should always suggest the search
for hernia. Of course I am detailing typical symptoms whicli
when present admit of no question as to treatment ; but in an-
other class of cases the question is more difficult for in these
the symptoms are latent. Twice in the past year I have had
referred to me cases of hernia that had suddenly become irre-
ducible. Apart from slight colicy pain and constipation and
the fact that the hernia could not be reduced there were no
symptoms, no excitement of pulse, no temperature, very little
tenderness, no nausea ; indeed, nothing to indicate strangu-
lation, and yet, in each case, operation revealed strangulation
Avith extensive gangrene of the gut, requiring resection.

If we suspect strangulation something active must be done.
The terrible mortality attending these cases is due to delay
in treatment, and when it becomes the rule to operate on

524 FIFTY-FIFTH ANNUAL, SESSION

all cases within the first six or even twelve hours, the story
will be different. Though it may be every doctor may not
feel willing to do an enterectomy and intestinal anastomosis,
every doctor should feel it his duty to cut down upon a hernia
and relieve the stricture, or he should see to it that some one
prepared to act is called at once.

True, it very often happens that the patient, used to more
or less trouble with his hernia, is slow to call in aid ; but this
only makes it the more imperative tliat the doctor shall no
longer delay.

Two methods of treatment may be restorted to : (1) Taxis,
or reduction by manipulation; and (2) operation.

Taxis may be used for a short time — twenty or thirty
minutes — if the hernia is of recent origin, or if it has been
previously reducible and if the symptoms of strangulation
are not of longer duration than six hours. Failing to reduce
the hernia, after this reasonable effort, an anesthetic should
be administered, taxis again tried for a few moments and, if
failure result, operation should be done at once.

It is perhaps most important to determine the limitations
of taxis :

1. Taxis is absolutely contra-indicated in irreducible hernia
becoming strangulated.

2. Taxis is absolutely contra-indicated in small hernia
giving rise to severe symptoms.

3. Taxis, if violent, has been known to rupture the mesen-
tery, leading to fatal hemorrhage.

4. Taxis may reduce a hernia en masse or may rupture a
gaiigrenouo gut, leading to the error of thinking the he^'nia
liLi been reduced or to fatal peritonitis.

5. Violent taxis often results in effusion of blood into the
intestine, thus favoring the transmigration of microbes and
the danger of gangrene.

6. The worst thing that can be said of taxis is that it too
often leads to false hope and disastrous delay.

The steps of the ordinary oepration, up to the point of re-

N. C. MEDICAL SOCIETY. 525

leasing the constriction, are so well agreed on they need no
disi^ussion, but when this point has been reached the gravest
questions will arise and the best judgment is demanded.

Of course if the gut is in perfect condition (and it will be
if you operate promptly) then there is nothing to do but push
it back into the abdomen and either close the wound or, if the
strength of the patient will permit, proceed to do the radical
operation. This is the ideal; but it too often happens that
the intestine is gangrenous or the appearance is one so doubt-
ful that even the wisest hesitate to act. If the bowel is gan-
grenous then there is open to the surgeon the choice of mak-
ing an artificial anus or of resecting the diseased portion and
doing an anastomosis by the method of his choice. Artificial
anus shows a death rate 25 per cent higher than does enter-
ectomy, and should never be done except in the presence of
extreme weakness of the patient, for if the operator does not
care to attempt an enterectomy I will later suggest a plan of
treatment which permits the patient being safely carried to a
hospital.

Hoffmeister declares when one decides to make an artificial
anus in hernia he practically declares the case lost. As to the
question of resection of the bowel, if one feels certain the gut
is gangrenous then primary resection must be done as soon
as possible, and as to the choice of methods I prefer the end
to end anastomosis by suture to either the use of some me-
chanical device or to the lateral anastomosis, if gut of the
same size is to be dealt with. After a little practice the end
to end anastomosis is not very difficult, and the Maunsell mes-
enteric stitch makes it very safe. If the gut looks healthy
one should carefully examine the mesentery, and if the veins
are thrombosed the gut, if left, will certainly die, and a re-
section must be done well beyond the thrombosed area or the
operation will be useless. Do not hesitate to excise as much
intestine as may seem necessary, for as much as eight or ten
feet may be removed without interferencs with nutrition;
and, apart from the time consumed in controlling bleeding

526 FIFTY-FIFTH ANNUAL SESSION

from the mesentery, it is practically as easy to remove several
feet as a few inches. The really difficult question is what to
do in the comjDaratively large number of cases where one is
uncertain of the necessity for resection. To enumerate, if the
strangulation has existed for a considerable length of time a
loop of intestine that looks and feels perfectly normal may
later become gangrenous, even after all constriction is re-
moved, for in most cases the degenerative process begins in the
mucous membrane and is not apparent on the peritoneal sur-
face till degeneration is well advanced. Dirty gray spots in
the gut usually means death of the part, but apart from this
the color does not give accurate information for "even dar>
blue intestine may be perfectly viable." The dark blue color
may not disappear under the use of gauze wrung out of hot
salt solution — the classic test ; and yet the gut be viable.
Feeble pulsation in the mesenteric artery indicates great dan-
ger to the gut, but the circulation may hi gradually restored
if thrombosis has not actually occurred.

When in doubt, then, it is best to wait some hours before
risking the dangers of a resection ; and in this event what shall
be done with the doubtful intestine ? Mosl authorities are
silent.

Graser tells us that it has been advised that the affected
loop be brought out on the abdominal wall and retained
there, while we wait for recovery of the gut. He condemns
this plan and advises that a rubber ligature be passed through
the mesentery and the loop of the intestine be dropped back
in the belly, to be withdrawn by the ligature if inspection is
desired. Cheyne advised that the suspected intestine be re-
placed in the abdomen loosely and withdrawn for inspection
later. To me the advice of neither is good, for in the one
case coughing or other unexpected movement might displace
the affected coil and make it hard to find ; and, in either case,
if the gut became gangrenous, the general peritoneum would
be exposed to infection. The plan I have used many times
with success is as follows : If in doubt the abdominal wound

N. C. MEDICAL SOCIETY. 527

is enlarged so freely that no constriction of the gut is possible
and the suspected loop or loops brought out and laid on clean
gauze on the abdominal wall. Gauze is now packed in the
wound so as to prevent any further extrusion of the intestines,
but with care to avoid compressing the suspected portion.
The mesentery of the affected bowel is now punctured with a
fine f orcep and a strip of iodoform gauze drawn through, and
this is later folded in the dressings to prevent retraction of
the bowel. The bowel is now covered with sterile gauze and
cotton and protected from pressure by an ordinary wire
kitchen strainer. The strainer is held in place by a few
turns of bandage, and over all is placed an abundance of cot-
ton wool to aid in retaining the warmth of the intestine. The
whole is held in place with bandages and the patient placed
in bed with light hot water bags applied over the dressing to
keep the parts warm, llany times I have used this simple
method when in doubt as to whether resection must be done
and, though it has not always succeeded, many times I have
opened the dressing twenty-four hours later to find the gut
fully restored and ready to be again put on duty.

Another advantage of this plan of treatment is that after
a few hours the patient is in better condition to stand the
resection if it must finally be done, for there is always de-
cided amelioration of the general symptoms as soon as the
strangulation is relieved, even though the gut becomes gan-
gi"enous.

Finally, I believe that if an operator is not willing to un-
dertake an enterectomy if he will go so far as to relieve the
strangulation, it is perfectly feasible by this method to trans-
port a patient to a hospital or to wait till help may be brought
to the patient.

528 FIFTY-FIFTH ANNUAL SESSION

HYDROCELE.

BY E. G. MOORE, M.D., ELM CITY, N. C.

The selection of this trite and seemingly unimportant sub-
ject has been for a dual purpose, neither of which is to dem-
onstrate any special knowledge which I possess or desire to
impart, but rather because of a lack of knowledge I have
chosen a subject so simple; and the further fact, because of
its simplicity, it receives but little consideration from those
who write, teach or preach on things surgical. I do not hope
to interest, entertain or instruct those of you who are trained
in surgical thought or specialize in surgical work, for I know
too well that larger ideas and greater thoughts encompass
your minds and attract your attention. Perhaps had I chosen
for my subject "The Absence of the Appendix," presenting
you with an array of statistics corroborating the views and
experiences of many writers and operators, I would have
captured your attention and provoked a discussion which
would have accorded me some little notoriety if not a repu-
tation. This and kindred subjects are fads that are strikingly
entertaining and peculiarly interesting; the periodicals and
the doctors alike are full of them ; hence little things often of
great value are frequently unobserved or entirely overlooked.
I take it that a large percentage of the membership of this So-
ciety devote their time and talents to the administration of
drugs in the practice of medicine, and give but little if any
attention to surgical thought or surgical procedure ; and yet
the subject under consideration is one of such frequent oc-
currence that it falls within the observation and experience
of every practitioner, and its recognition and treatment are so
simple that every doctor, though not a surgeon, should recog-
nize and take care of these cases at home. I have seen a regi-
ment of prostates but not of hydrocele ; yet I have seen it in
infancy, in youth, in manhood and in old age, and no donbt
you have seen this also, since this disorder prevails wherever
the footiDrint of man is found.

N. C. MEDICAL SOCIETY. 529

The more common form of hydrocele is that of the tunica
vaginalis, and consists of a collection of serous fluid within
this cavity. It is usually unilateral, yet may be bilateral.
Its history is that of a slow and painless swelling, usually
first observed in the lower or dependent portion of the scro-
tum and gradually extending upwards as the fluid accumu-
lates. In shape it is oval or pyriform, having its broadest
surface below. It is smooth and uniformly tense and often
has a semi-elastic feel, but may become so tense and hard as
to present to the sense of touch a strong resemblance to a solid
body. In most cases the fluid is of an amber or straw color
and may vary in quantity from a few to many ounces. In
recent cases the sac walls are thin and hence fluctuation is
more easily made out; but in old or chronic cases the walls
are thickened or indurated and give rise to the appearance
and feeling of a solid tumor. From the inner or serous sur-
face of the sac wall exudes a secretion which gradually fills
up the tunic space and produces the cystic condition which we
call hydrocele.

It may be differentiated from a diseased testicle, varicocele
or hernia, the last named being more frequently confounded
with a proper diagnosis perhaps than any other condition.
But when we recall that in hernia the swelling begins at the
inguinal ring and travels downward; that if it is reducible,
upon assuming the recumbent posture, with and sometimes
without manipulation it disappears; that it has a soft or
doughy feel and gives an impulse on conghing; and that in
hydrocele we have a slow and painless growth, beginning be-
low and extending upwards, first soft, then elastic and then
tense, that position has no effect upon its relation and that
its one distinguishing feature and characteristic is its trans-
lucency to transmitted light, there should be no error made.

The treatment of hydrocele is ptilliative and radical. Sim-
ple tapping of the tumor relieves the accumulated fluid, and
this is often curative; yet the tendency is to reformation.
After withdrawal of the fluid irritation of the membrane with
34

530 FIFTY-FIFTH ANNUAL SESSION

the point of the needle or stylet so as to get up some inflamma-
tory action is a better procedure still. The injection method
of Levis preferably with carbolic acid, a clear description of
which is given in the text-books, is curative in a still larger
number of cases and is estimated on a percentage basis of
seventy-five to eighty-five per cent. This treatment is prac-
tically painless and properly used is void of danger. It is
specially adapted to recent cases and in young subjects with
thin sac walls. In the more obdurate and chronic cases of
long standing, with large accumulation of fluid and thickened
sac walls, the injection method is frequently met with failure,
and then the open method by incision or excision or both is
not only the method of choice but the certain means of cure.
It matters but little except as a personal choice of the indi-
vidual operator what disposition be made of the sac ; whether
partial or complete excision, or everting it so as to envelop
the testicle and stitching the edges with catgut ; the idea and
object to be sought is the obliteration of the sac, for this af-
fords the only positive assurance of a complete cure. The
technique of these procedures are to be found in the books of
surgery and need not be repeated here. Make your diagnosis
and exclude diseased testicle, variocele and hernia. In very
young children tapping, followed by irritation with the point
of the needle, is usually sufficient. In older children or in
all recent cases tapping followed by carbolic acid injection
gives greater promise of better results. Such cases as are not
eured by the injection method often respond to the incision
method of Yolkmann, but destruction of the sac is perhaps the
only certain guarantee of a cure.

N. C. MEDICAL SOCIETY. 531

CONSERVATISM IN RAILWAY SURGERY.

BY W. P. WHITTINGTON, M.D., ASHEVILLE, N. C.

In presenting this paper I do not wish to do so in a spirit
of criticism, but wish to say something that will be of benefit
to the surgeon, both civil and railway, and that will possibly
be the means of saving the life or a useful limb of some un-
fortunate victim of a railway accident.

The position of a railway surgeon is a dual one: profes-
sional and diplomatical. His professional duty would require
him to consider specifically the relief and safety of his pa-
tient, while as a railway official he must take into considera-
tion the interests of the company by which he is employed.
In reality he should and must have at heart the mutual inter-
est of both. AVhile this is very desirable, it is still a hard
matter to eliminate the influence of the employer over the
employed and do justice both to the railway and the injured.
The powers and influence of the surgeon over public opinion
is such that he may easily favor his employer, and at the
same time make it appear that he has done the best possible
for the injured.

Eor instance, the surgeon may be called to a patient with
a mangled hand or foot that looks to the layman to be beyond
repair or out of the power of the surgeon to save. The sur-
geon knows that if the limb could be saved it would require
a long, tedious watching and careful antiseptic treatment.
He also knows that if he amputates above the injury he has
healthy tissue, a clean stump and that in two or three weeks
the patient is well, but minus a member that might have been
saved and have been of great benefit to the injured.

In such a case the surgeon is commended for doing the
best thinsf possible for his patient. The patient is furnished
an artificial leg or given a small compensation for a hand,
and goes through life maimed and worth but little to himself
and family; when if he had bo^n treated antiseptically this

532 FIFTY-FIFTH ANNUAL SESSION

limb would have been saved and w^oiild have been a great
blessing to himself and family.

I know a man who had a badly lacerated hand and his sur-
geon told him it must be amputated. The patient refused to
have it done. The surgeon told him that he would have to
put him to sleep before he could dress it. The patient sub-
mitted to the anesthesia, but told the surgeon that if he am-
putated the hand he would kill him. The hand got well and
the man can do any kind of work. He has a crippled but
useful hand.

I know a man who had a com2)Ound comminuted fracture
of the leg, opening up the ankle joint. It looked like an im-
possibility to save the foot. The foot was wrenched to one
side so that the ankle was dislocated and the end of the tibia
protruded through the skin. A drainage tube was passed
clear through the joint, and the leg was treated antiseptically.
The man got well with a useful foot and leg, but with a lim-
ited amount of motion. I could report a great many cases of
extensive laceration, fractures, contusions and mangled condi-
tions that have been saved by patient and persevering anti-
septic and supportive treatment. While, on the other hand, I
have seen valuable limbs sacrificed for want of such treat-
ment. One might say that it is best not to subject our patients
to so great a risk as is necessary to carry out an expectant
antiseptic course of treatment ; that there is danger of sepsis.
gangrene and death. That there is always some danger we
will admit. The surgeon should be very alert, and when bad
symptoms appear he should pursue such method as is neces-
sary to remedy the threatened evil. AVe are not justified in
amputating a foot because a nail has pricked the heel and we
are afraid the patient might have tetanus. The method to
pursue in these cases of railway and other injuries to the ex-
tremities is one of thorough antisepsis from the beginning.
The patient should be cleansed as thoroughly as possible with-
out further contaminating the wound. The injured limb
should then be thoroughly washed with soap and water, hi-

X. C. ilEDICAL SOCIETY. 533

chloride of mercury, one in two to four thousand, owing to
the extent of the injury. This should be followed with alcohol
and ether and finally rinsed with bichloride. In extensive
injuries, where there is a great deal of denuded tissue, it is best
to continue a wet dressing of a saturated solution of boracic
acid or sulphate of alum. In very extensively mangled legs
or arms the limb may be immersed for from twenty-four to
seventy-two hours in a saturated solution of sulphate of alum.
This solution of sulphate of alum is not extensively used, so
far as I am informed, but it is practically harmless and has
fine antiseptic powers and acts as an astringent on the ex-
tensively lacerated and bleeding tissues. As soon as the
bleeding ceases and if the tissues show an anaemic appear-
ance the solution should be discontinued or made weaker.
Dry or moist antiseptic dressings should be continued and
sloughing surfaces separated as early as possible, care being
taken not to open up raw surfaces more than is necessary, as
such a proceeding would encourage the absorption of septic
matter. Another good method is, after the parts are thor-
oughly cleansed with soap and water, to mop the raw surface
thoroughly with pure carbolic acid followed with 95 per cent
alcohol, and paint it thoroughly with tincture of iodine. After
healing has taken place it may be necessary to do plastic ope-
rations to complete the work that nature failed to do.

634 FIFTY-FIFTH ANNUAL SESSION

REPORT OF A CASE OF TYPHOID CHOLECYS-
TITIS. OPERATIO^T, RECOVERY.

BY WM. A. GRAHAM, M.D., DURHAM, N. C.

Typhoid fever is now generally recognized as being impor-
tant in the etiology of acute and chronic disease of the gall
bladder. Many of the cases of acute infection are overlooked,
or are mild enough to subside during the course of the dis-
ease ; hence it is difficult to determine the percentage of cases
of typhoid which have acute infection of the gall bladder.
The percentage is probably larger than is generally accepted,
and the following case is reported as illustrating the con-
dition :

J. B. A., eighteen years. School and farm work.

Family History. — Father at 44; mother at 36, and one
brother at 10 died of typhoid fever. Two sisters and two
brothers living and well ; all recovering from typhoid.

Previous History. — Measles, whooping-cough, mumps and
acute rheumatism in childhood. ISTo other serious disease.

Present Hlness. — First seen July 25, 1907, and admitted
to Watts Hospital. Had spent previous week at Jamestown
Exposition and returned sick. Symptoms presented were
those of a moderately severe typhoid at about the end of the
first week. The diagnosis seemed positive and no Widal re-
action was taken and no blood count made. The disease ran
a typical course, with evening temperature 103 to 104 de-
grees until the eighteenth day, when an enema brought away a
large quantity of stale blood. Further hemorrhages oecurn^d
on the nineteenth, twentieth and twenty-first days, and were
treated with morphia and adrenalin hypodermically, with
ice locally. A voluntary stool on twenty-third day showed no
sign of blood. The temperature fell at the time of hemor-
rhage and remained low until the evening of the twenty-fifth
day, when it rose suddenly to 102 degrees. This was repeated
on the twenty-sixth day, with severe lancinating pain over

K. C. MEDICAL SOCIETY. 535

right upper abdomen and liver, more marked on deep inspira-
tion with a gradual rise of pulse from 88 to 106, and respira-
tion from 24 to 36 per minute. Examination showed local
tenderness along edge of ribs, and moderate rigidity of right
hypochondrium. There was distinct friction rub on ausculta-
tion over liver and edge of ribs, which spread over a larger
area in the next few days, finally extending from sixth rib
above to appendiceal region below; but best heard in gall-
bladder region. There was no jaundice at any time. Pain
continued severe, most marked when stomach or colon was
distended; vomiting occurred daily and urine showed pres-
ence of bile. Temperature was irregular but not over 102
degrees. In forty-eight hours a tense tender gall bladder
could be palpated when there was no distention of the colon,
but was not palpable when the colon was distended. Repeated
vomiting and distention of the stomach prevented the patient
from taking food, and a gradual failure of general strength
demanded operative relief.

Operation. — Under ether laparotomy was performed
through the right rectus on the thirtieth day. At operation
widespread spider web adhesions were found between stom-
ach, duodenum, colon and parietal peritoneum. The gall
bladder was tense, very dark in color, and bound down to the
hepatice flexure by a dense adhesion deep in the abdomen, at
which point perforation would probably have occurred. In
freeing it there escaped several ounces of fluid, at first thought
to be bile, but probably serous fluid from the local peritonitis
as the bladder remained distended. Bladder was raised to
the abdominal wall, aspirated, freely opened and no stones
found. Walls of the bladder were much discolored but other-
wise in fairly good condition. Bile obtained on aspiration
was very dark, with a few white flakes suggesting the begin-
ning of suppuration. Bladder was stitched with chromic gut
to the parietal peritoneum, drained with rubber tubing, rub-
ber gauze drainage placed above colon and wound closed with
through and through silk-worm gut stitches. It is to be re-

536 FIFTY-FIFTH A^':^'LTAL SKSSIOX

gretted no bacteriological examination of the bile was made.

Post-operative History. — Hemorrhage from the bowels oc-
curred twenty-four hours after operation, and was again con-
trolled by morphia and adrenalin. Except for this convales-
cence was uneventful, though prolonged from continued drain-
age of bile with a tendency to the fonnation of a biliary Hs-
tula. Patient dismissed five weeks after operation and at
present is in excellent health.

Points of interest in the case are found especially in the
diagnosis and indication for operation.

Diagnosis may be difficult or easy, depending often on the
mental condition of and the aid to be obtained from the pa-
tient. In this instance the symptoms were strongly suggestive
of diaphragmatic pleurisy for the first two days. Pain worse
on deep breathing, friction rub on auscultation heard on both
expiration and inspiration, though best at the end of inspira-
tion ; rise of pulse and rather disproportionate rise of respira-
tion pointed to pleurisy. Vomiting, the fact that the pain
was abdominal and increased by distention of the colon, care-
ful location of the tenderness, and finally, palpation of the
distended gall bladder rendered the diagnosis positive.

Indication for operation, as against further expectant treat-
ment, was based on the gradual spread of the local peritonitis,
with continual severe pain and vomiting, inability to nourish
the patient, the possibility of rupture and the avoidance of
suppuration. There had been no chills or marked sweating
and it was not thought that suppuration had occurred. In
fact, it was believed that this particular patient's chance of
recovery depended on drainage before he w^as subjected to
septic symptoms from suppuration, and the findings at opera-
tion would seem to show the wisdom of comparatively early
laparotomy in these cases.

X. C. MEDICAL SOCIETY. 537

APPEK'DICOSTOMY IN AMCEBIC DYSENTERY.

BY BRODIE C. NALLE, M.A., M.D.,
Professor Id N. C. Medical School, Charlotte, N. C.

The operation of appeudicostomy is a comparatively new
operation, and, so far as I can find from available literature,
no case has been reported from North Carolina.

Therefore, I thought it worth while to report this case.
In short, the operation consists of the fastening of the appen-
dix in an abdominal incision in order, through the lumen
of the appendix, to apply irrigations to the colon.

This operation has been performed probably less than one
hundred times, with no deaths due directly to the operation ;
a fact which should commend the operation and make us con-
sider its performance in our cases of obstinate affections of
the large intestines, whether these affections are due to amre-
bas or other causes.

Here in the South we certainly need help in our intractable
cases of dysentery, and my object in reporting this case is
with the hope of influencing some of the members of this
Society to try this operation in those cases where medicine
fails.

My case was a woman, forty-eight years old, who had suf-
fered from several attacks of amoebic dysentery which, up to
the last attack, had been relieved for a while by rectal irriga-
tions of quinine solution. Recurrences became more frequent
and the last attack could not be relieved by rectal irrigation.
In fact, the condition of the rectum made such irrigation un-
bearable. The list of internal medicines was faithfully tried,
with no improvement, but with the rapid failing of the pa-
tient.

At this time the patient was having from twenty to thirty
bloody mucous movements a day, with severe pain and ten-
esmus.

538 FIFTv-riFTll ANNUAL SESSION

Physical Examination. — Patient very anaemic and terribly
emaciated. Pulse 120 to 130 ; temperature as high as 102 F. ;
heart and lungs normal. A mass the size of a hen egg at the
pylorus, which, after a chemical examination of the stomach
contents, we felt justified in diagnosing cancer of the stomach.

Microscopic examination of the stools showed amoebae in
great numbers.

At the request of the patient and her family to do some-
thing to relieve her suffering the operation was performed.
The usual technique was followed, with the exception that we
entered the lumen of the appendix at the time of the operation
and started saline irrigation immediately, instead of waiting
tlie usual two or three days for the sloughing of the end of
the appendix. This was done from necessity, since it was
obvious that the patient would not live Avithout immediate
relief. The irrigations brought away large quantities of blood
and mucous for several days, with only four to six movements
a day, and these were with almost no pain or tenesmus. On
the fourth day quinine irrigations were substituted for the
salt solutions, with a continued improvement in the character
and number of the movements. On the tenth day the patient
had only two movements in addition to the one following the
irrigation. Daily irrigations of salt were now kept up for
five weeks, with a steady improvement in the condition of the
patient. At this time the patient was greatly improved and
her condition, in spite of the cancer of the stomach, was very
gratifying, and had the meeting of this Society been a few
days earlier my paper would have ended more pleasingly.

When I thought the patient well of her dysentery I was
called suddenly to find her suffering from a severe hemor-
rhage of the stomach, which she survived only a few hours.
This ending, however, does not deter me from calling your
attention to the prevalence of amoebic dysentery here in the
South, and to the fact that in many cases it is not diagnosed.

The diagnosis by means of the microscope is certain and
easy, and for this reason we are to be blamed if we do not

X. C. MEDICAL SOCIETY. 539

make our diagnoses early, and are willing to call our cases
tuberculosis of the bowels, etc. I do not advocate tbe opera-
tion of appendicostomy for every case; far from it, but put
in a plea for its trial in those cases which do not improve
under internal medication and rectal irrigations. Many cases
can be cured by carefully administered irrigations of quinine
or thymol, but some will not respond to these methods of
treatment, and others, owing to the condition of the rectum,
can not be treated with irrigations.

To repeat, amcebic dysentery is common here in the South,
it is on the increase; it produces rapid anaemia and emacia-
tion, and is often fatal. The treatment is easy and effective,
whether it be by irrigation or by this operation. Therefore
it is not to our credit to let these cases go undiagnosed or fail
to attract our serious consideration.

]^o description of the technique of this operation nor of the
symptoms and pathology of this disease has been attempted,
as all of these have been much more ably presented than can
be done by me.

I only wish to place my case on record and interest you, if
possible, in the fatality and common occurrence of this dis-
ease here in ISTorth Carolina.

540 FIFTY-FIFTH ANNUxiL SESSION

LOCAL ANESTHETICS IjST SURGERY.

BY JOHN A. WILLIAMS, M.D., GREENSBORO, N. C.

No doubt in selecting the subject of "Recent Advances" in
surgery the doctor knew that I could not give in one short
paper all the recent advances and modern improvements in
surgery within the last year or so. It would take a paper of
considerable length, and then I would only be able to give a
smattering idea of the wonderful improvements made along
this line of the profession within the last few years. I have,
therefore, taken the liberty of selecting one branch of this
great subject, that I may go more deeply into detail and have
it discussed more fully by members of this body.

I have chosen, therefore, as my subject upon this occasion
"Local Anesthetics in Surgery." There has been such an
improvement along this line from a surgical standpoint within
the last few years that I think it worth while that each of us
should give more time and study to this individual branch of
work. Not only does this bring foi'th a subject interesting
from a scientific standpoint, but also from a financial point of
view.

It is a well-known fact that there are a great number of
people who absolutely need an operation, and would have the
work done readily if it were not for the fact that they would
have to take a general anesthetic. Of course we all know that
we can not do all operations under local anesthetics. How-
ever, when I say a great deal more can be done than we do,
I by no means exaggerate the use of this mode of anesthesia.
I have seen within the past year over fifty cases of hernia,
four cases of appendectomy and numbers of cases of varico-
cele, and hemorrhoidal operations a la galore, as well as all
kinds of tumors, etc., removed by this mode of anesthesia,
comparatively painless and without harm to the patient. I
admit I myself was astonished at the immense amount of
work that could be accomplished along this line of work.

N. C. MEDICAL SOCIETY. 541

Wheu I began to look into this factor from a surgical stand-
point I found a great deal could be accomplished by simply
giving a little time and patience to this mode of anesthesia.
One reason local anesthesia is not more widely known and
used is because the surgeons have given so little time to the
matter and have never learned the "modus operandi" of using
these "Godsend methods" to humanity.

I will name the most important of these methods used and
give a little time to each, hoping that you may hereafter study
them more closely, and come to your own conclusion as to
which is best for your patient and yourself. The following
is a list of those used up to the present day : 1, Water ; 2, Kee-
lene; 3, Ethyl Chloride; 4, Ethyl Bromide; 5, Adrenalin;
6, Eucaine ; 7, Stovaine ; 8, Tropo-cocaine ; 9, ISTovocaine, and
10, last but not least. Cocaine.

1, Water sterilized may be used to excise small cysts, warts,
fatty tumors, etc. If used properly these small tumors can
be easily and painlessly removed. You will have to take
time, injecting and infiltrating the tissues slowly, thus caus-
ing pressure on the nerve terminals, finally causing paralysis
of the terminals, so you can do a painless operation. If the
infiltration is too rapidly done it causes pain and thereby you
lose what you were aiming to gain.

2, Keelene ; 3, Ethyl Chloride. These are used as a method
of freezing the parts. They are used in the form of a liquid
spray, spraying the parts until thoroughly frozen. If there
is much inflamation the freezing will have to be deep, and
you have to operate quickly, as this mode of anesthesia only
lasts a short while. I have known where the parts are frozen
deep, that in thawing it will frequently give rise to pain.
Either one of these can be u.sed to anesthetize a spot for the
hypodermic injection, the first penetration of the needle in
using the other methods, which I '^hall mention. Ethyl Chlo-
ride is considered by far the best and less harmful of the three,
and therefore more widely used. This method is of great
benefit — small abscessed boils, felons, etc. I have used this

542 FIFTY-FIFTH ANNUAL SEvSSION

method very successfully in some cases, and I have again had
it to give a great deal of pain, to my disgust as well as to the
patient's.

5, Eucaine. I must say I have never used this, while it
is a synthetic compound used in the place of cocaine, and some
claim it a great deal less harmful. It is said to be of great
service in nose and throat work in conjunction with ad-
renalin.

6, Adrenalin. This has same anesthetic powers, chiefly
by contracting the capillary blood supply, it acts indirectly as
an anesthetic and is of great service in nose and throat woi'k,
especially of great service when used with novocaine.

7, ISTovocaine. Mono-hydrochloride. This is a synthetic
compound. It comes in crystals, and easily dissolves — equal
parts of water and alcohol. It is similar to cocaine in its
action. It is said to be by far less toxic than any of the sub-
stitutes for cocaine. It can be used in 5 to 20 per cent solu-
tion for injection, and even stronger for local application^3
without harm. When injected it exerts a powerful anes-
thetic effect, but of very short duration. The prolongation
of its anesthetic effect may be greatly facilitated by the addi-
tion of six or eight drops of (1 to 1,000) solution of adrena-
lin. It gives rise to no irritation and used very successfully
in minor surgical work.

8, Tropo-cocaine. Tropo-cocaine-hydrochloride. This is
a synthetic compound resembling cocaine in its action, being
about one-half as toxic, therefore double the strength or quan-
tity can be used. The anesthctio effect is said to be much
more rapid and lasts longer than any of the substitutes for
cocaine. Its action is greatly facilitated by the addition of
a small quantity of sodium chloride (6-10 of 1 per cent), or
better by using a normal salt solution in surgical work.

9, Stovaine. This is a synthetic compound. It is the
hydro-chloride of Dimethylamine-beta-benzyolpentanol. It is
similar to cocaine in its action, but far less toxic, being almost
free from toxicity. It has no vaso-constrictor action, and

I>r. C. MEDICAL SOCIETY. 543

therefore does not give rise to vertigo, nausea or syncope. It
is incompatible with the alkalis and their reagents, mercury
and iodine componiids. It is used very successfully in the
removal of small tumors, opening of abscesses, boils, etc.
The addition of a little salt aids in anesthetic properties.

10, Cocaine. Cocaine anesthesia is an old and tried
method. It is a well-known fact that the cocaine anesthesia
is more widely known among the profession than any other
of these preparations. Some have used it from time '"im-
memorial." Others have used this method only to their
sorrow and disgust, determined to lay it aside never to use it
again.

I said before, this use of local anesthesia requires more
time and patience in its use than does a general anesthetic.
It also requires a great deal of skill, and it is a great deal
more tedious to the surgeon doing the work than it is to work
under a general anesthetic. Therefore, when it is used we
should charge a great deal more for the work done instead of,
as is customary to charge less. Dr. Wyeth, of New York,
used to charge, and does yet, just twice as much for an opera-
tion with cocaine as he does with under general anesthesia,
and it is nothing but right that he should. When properly
studied and used, cocaine is, to my mind, the chief and great-
est of local anesthetics. It has been brought into somewhat
disrepute by purely the ignorance of its use. While theie
are some idiosyncrasies to cocaine as to almost any drug, they
are few, and the bad effects of its use is a great deal more
often due to not knowing how and the discriminating use of
it. As any other anc^^thctic, it should be used with the i)a-
tient lying dovm, and the syncope effect Avill be vastly elimi-
nated. The patient should always have a good drink of
whiskey and a hypodermic (-| to ^) of morphine one-half
hour before the operation, as both have a tendency to counter-
act the depressing effect it may have on the heart and respi-
ration. Just as the operation is begun give another drink of
whiskey. Always, as in any other au esthetic, have a hypo-

544 FIFTY-FIFTH ANNUAL SESSION

dermic of morphine and strychnine ready to be given at any
time. This being done, the infiltrating method (being first
introduced by Sleick, of Germany) of using cocaine is easily
done,

Sleick had three solutions, strong, medium and weak.

First.

Cocaine gr. 3

Morphine gr. |

Salt gr. 3

Water oz. 3-|

Second.

Cocaine gr. 1-|

Morphine gr. f

Salt gr. 3-1

Water oz. 3-f

Third.

Cocaine gr. |

Morphine gr. |

Salt gr. 3

Water oz. 3-f

He only used the first solution when there was a great deal
of inflammation and sensitiveness. The second he more often
used for skin infections, and the other tissues with the
weaker, third solution.

Bodine uses a solution of 1 to 500 for his skin injection,
and 1 to 1,000 for subcutaneous injections. This is what I
have seen and used mostly myself. The first puncture of the
hypodermic needle is the only pain comparatively. This can
be remedied by the use of ice or a little ethyl-chloride to begin
with. After the first puncture, infiltrate the superficial skin,
withdraw the needle and insert behind the edge of the first
infiltration. This is kept up until the length of skin you
want to incise has been anesthetized. Then go back and
with the 1 to 1,000 solution you infiltrate the subcutaneous
and deeper tissues. This method being used in fifty or sixty
cases of herniotomy (I have seen), also in three cases of
appendectomy, several cases of amputation of the thigh, and
in a majority of cases of minor surgery of the rectum. Dr.

N. C. MEDICAL SOCIETY. 545

Lynch, of the Eectal Surgea, says that while all cases of
rectal surgery can not be done with cocaine, that by selecting
your cases the majority of such work can be. He has done a
nnmber of Whitehead's operations for hemorrhoids by this
method of cocaine infiltration. Out of the cases that I have
seen operated on, I have never seen any ill effects whatever.
I have a number of times seen four or five inches of omen-
tum ligated and cut off in hernia operations. The whole
operation is absolutely painless, extending over an hour and
not over a half or three-quarters of cocaine used. Of course
there is a certain class of patients, of a nervous, hysterical
nature, that nothing less than a general anesthetic will do,
as the pain is more mental than real; but when we stare
these facts in the face, and really see what can be done by
their use and in such small quantities, we can only say there
is a great future for its use. I agree with Dr. Lynch, that
after using all, or nearly all, that this method of cocaine infil-
tration as a local anesthetic in surgical work by far exceeds
all the rest.

546 FIFTY-FIFTH ANNUAL SESSION

SOME POINTS m MINOR SURGERY.

BY W. J. MCANALLY, M.D., HIGH POINT, N. C.

As the general practitioner of medicine is the one who must
do most of the minor surgery, it is therefore not amiss for a
general practitioner to discuss this subject. In the course of
my work along this line some things I have observed have ap-
peared very important and impressed me forcibly. All men
make practical and useful observations in their work, and
thus is the store of useful information ever increased. Should
be glad to draw from you some of your ideas which you have
formed from careful study of your work. If some of the nug-
gets of truth which men here have dug up are not presented
to this meeting after I sit down it will be because your inter-
est is not aroused. In treating a great many injuries of the
hands and face the astonishing power of repair possessed by
the tissues of these parts has impressed me much. It would
seem as though there is no limit to what may be repaired
about the hands and face. With bones cut or crushed and
tissues destroyed and blood supply nearly or quite cut off,
yet much can be saved. And, as it is usually a man who la-
bors with his hands for his daily bread, it is very important
to save every particle of the hand and fingers possible. To
save the parts is more important than to make them neat. No
shreds or tags or flaps of skin or tissue having any attachment
should be cut away when dressing an injury to the hands.
For every such particle of tissue about an injury here will
rapidly throw out granulations and assist materially in the
process of repair. Often the patient will complain when an
effort is made to save what appears to him to be a hopelessly
injured finger. But the vitality and power of repair in that
finger is marvelous and it should not be sacrificed because of
his lack of faith. A safe maxim is never to cut off any part
of an injured finger or hand at the time of first dressing. If
proper dressing is applied no injury will follow the necrosis of

N. C. MEBICAL SOCIETY. 547.

a flap or even a finger or more. And any necrotic parts may
be removed at subsequent dressings or allowed to slough off.
Another consideration is sutures and ligatures. As the saving
of every particle of tissue is of first importance in treating
injuries to the hand, we ought to put in just as few sutures
as can be gotten along with, for sutures and ligatures con-
strict and strangiilate tissue and cut off a certain amount of
blood suj^ply. A suture near the base of long tag or flap may
destroy its feeble blood supply and cause necrosis. Again too
heroic etloits to cleanse the wound will lessen the vitality of
the parts. Many of the injuries treated in our town are pro-
duced by wood-working machinery and the material used
upon these machines is thoroughly kiln-dried, and many clean
cuts by these saws and knives are never washed by any anti-
septic solutions or even sterile water. To avoid injury to
the parts the tags and scraps of an injured finger or hand
are gently placed in position after first cleansing my own
hands in strong bichloride solution, and then dressed with
gauze saturated in balsam peruv., no sutures being placed at
all. The blood which was allowed to remain upon the wound
will hold the parts in position. ISTow, if this first dressing is
wisely allowed to remain on for five to seven days, and kept
moist for the first two to four days in a solution of Ac. Car-
bolic one drachm, Sod. Bicarb, six drachms to aqua one quart,
there will be no congestion or inflammation. The moist dress-
ing keeps the injured part comfortable by preventing conges-
tion. And any congestion or inflammation in the tissues of
hand or fingers is very painful because of the abundance of
cellular tissue here. The moist dressing aids repair by pre-
venting congestion.

Another important consideration in the saving of these in-
jured parts is the medico-legal side. The injury may often
be very substantially minimized by conservative efforts and
in this day of unending, never-ceasing law suits, verdicts for
damages.

548 FIFTY-FIFTH ANNUAL SESSION

CAEBUNCLE— ITS ETIOLOGY, PATHOLOGY, ETC.,
WITH A TREATMENT COMMENDED.

BY THOS. E. ANDERSON, M.D., STATESVILLE, N. C.

Mr. President and Gentlemen of the North Carolina Medi-
cal Society: — My apology for afflicting this Society with this
somewhat homely and melancholy subject will find justifica-
tion, I hope, in a treatment which I propose to exploit. First,
let us take a glance into the etiology, pathology, etc., as viewed
by present day observers. Carbuncle was formerly looked
upon as a peculiar, mysterious disease, having a pathological
process of its own, with little or no relationship to any other
disease, either in its etiology, its pathology or its indications
for treatment. And owing to the allurements of visceral
surgery and the more remunerative and inviting fields in the
dark, unfathomed caves of the human organism, we are still
in bondage to the traditions of the older pathologists, this
being one of the more common diseases which have received
scant attention. In this belief I essay to ascertain and corre-
late what is known of the cause, nature and treatment of
carbuncle. The observation has often been made, and should
be reiterated, that the names anthrax and malignant postule
should no longer be used interchangeably with carbuncle. To
avoid confusion the former anthrax should be only applied
to that disease of the lower animals which is contagious, some-
times communicated to man, and is caused by the ^'anthrax
bacillus ;" while the latter term, carbuncle, should be reserved
exclusively to designate the disease under consideration. Car-
buncle is a disease of microbic origin like all of its class. This
being abundantly demonstrated by several observers, of whom
Gawe, Bockhardt and Baum are most prominent.

The micro-organism most frequently found is the "staphy-
locuccus aureus." In the minority cases there are present also
the staphylococcus albus or the streptococcus pyogenes, or the
two together with the first; but always outnumbered by it.

N. C. MEDICAL SOCIETY. 549

The coccus may enter the skin through the hair follicles, the
sebaceous gland ducts, the sweat glands or an abrasion of the
epidermis. The theory of entrance to the body through the
alimentary canal or respiratory tract is by analogy an en-
tirely tenable one. We are nowhere more in bondage to the
traditions of the elders than in the belief that this disease is
of constitutional origin ; the notion that it is a disease of the
cachectic, the alcoholic, the tubercular and the diabetic w^as
readily accepted and easily believed before local causes were
demonstrated. The most that can be rightly claimed for the
constitutional factor is that it lowers the general resisting
powers, increases the vulnerability of the tissues, and thus
allows free entrance to the casus morbi. Even the diabetic,
so prominently associated with carbuncle, does not often have
this complication. Though there are no statistics at hand to
prove it, it is a matter of doubt whether it is found more often
among the cachectic classes than in those of good health. This
idea of ascribing it to the cachectic probably grew out of the
fact that statistics were gathered more from almshouses and
public hospitals, rather than from private practice. However
this may be, it is certain that whoever ignores the local origin
and local nature of the disease scatters abroad and is handi-
capped and disarmed in the proper treatment of his patient.
Carbuncle is a disease of middle life, v.^hile furuncle is a dis-
ease of the adolescent. Viewed pathologically carbuncle is
an acute suppuration of connective tissue, and hence is gen-
erically related to osteomyeletis, parenchymatous abscess,
acute abscess, furuncle and other suppurative diseases of the
skin. The region of predilection of carbuncle is the dense
and fibrous integuments over the posterior median line of the
body. The skin of this region is characterized by its extreme
thickness, especially the relative thickness of the cutis vera,
and the aponeurotic-like density of the papillary layer, and its
having few and small openings. The pus coccus having passed
down and invaded these tissues a focus of inflammation is be-
ffun, and we have all the factors and conditions necessary for

550 FIFTY-FIFTH ANNUAL, SESSION

the production of a typical carbuncle. The delicate areolar
adipose tissue succumbs and liquefies, and as tension increases
pus is forced to the surface bj mucous along the lines, or of
the hair follicles, its only avenue of escape; as tension in-
creases the inflammation is forced to extend laterally farther
and farther from the original focus, and thus we have the
hard elevated outlines.

As my object in this paper is purely or mainly to call your
attention to a mode of treatment which I had never seen advo-
cated up to this time, and which gave such prompt relief in
a case falling imder my care, I shall not longer incorporate
into this article the painstaking research of another from
whom I have culled most liberally and bodily — a paper read
before the last Pan-American Medical Congress at its meeting
in Washington City by Dr. D. W. Graham, of Chicago, 111.,
the data in the usual channels being very meagre. The his-
tory of means and methods of treating carbuncle would fill a
volume. Many good surgeons advocate a purely expectant
course and discard all active means, relying on internal medi-
cation, and treating it as a self-limited disease. Caustics, in-
cisions, single, multiple, and the honored crucial incision are
relied on by others. These are to be recommended in the
absence of more efficient means ; but they all fall short of the
end desired. Then the method of injection of dilute carbolic
acid and various antiseptics has its advocates. But it is not
my purpose to review and compare discarded or prevalent
methods. As a substitute for all of these I would advocate
''total extirpation'' of the indurated mass, just in the same
manner as we would remove a benign tumor. And if this is
done early the entire skin can be saved, as was demonstrated
in the case which I am about to relate.

Along in the early spring Mr. N. B. M., aged about forty-
five, in a somewhat run-doAvn state of health — one of our
most enterprising and wealthy citizens, was the victim of
this most malicious foe to happiness. The site elected for the
exhibition of its relentlessness was the one most popular.

N. C. MEDICAL SOCIETY. 561

namely, the nape of neck. Commencing by darting pain,
some heat and swelling, it surely and steadily fastened itself
upon him; and while a man of large possessions he became
entirely oblivious of all except the possession of this vicious
carbuncle. I tried various and sundry applications, the mean-
while securing for him some relief by full hypodermic doses
of morphine. The symptoms hourly grew worse ; heat and
swelling increased ; the whole back of the neck became red and
tense ; there was some delirium and color suggested septic in-
fluences at work; the patient was anxious and apprehensive;
indeed I feared meningitis might ensue. The sources of our
knowledge, the books, availed me but little. The tumor by this
time elevated and outlined, a hard mass. It occurred to me
that while the skin still maintained its integrity why not make
a cross incision and dissect out the involved tissue ? Calling
my able friend, Dr. H. F. Long, to my assistance, who after
some deliberation fell in with my idea, we proceeded without
delay to anesthetize him, and under the rules of modem
surgery entirely removed the indurated mass, first carefully
dissecting back the skin ; packing with iodoform gauze, sutur-
ing the edges of the skin together and applying over all a lib-
eral supply of same gauze completed the operation.

Fever, pain and all the existing evils at once subsided;
he did not need another dose of an opiate ; his exiled smiles
returned, and he made a prompt though somewhat slow re-
covery as the excavation had to fill up by deposit; yet there
was no more pain and much time was gained over the slow
processes of suppuration, not to speak of the wasting of the
body and the sleep murdered.

I had never seen or heard of this procedure before, though
many here may be familiar with it. I offer it to those un-
familiar with it, and commend it as the best way to subdue
this stubborn and painful foe.

552 FIFTY-FIFTH ANNUAL, SESSION

CHONDROMATA, AND REPORT OF A CASE UN-
DERGOING MALIGNANT DEGENERATION.

BY EUGENE B. GLENN, M.D., ASHEVILLE, N. C.

A chondroma is a tumor composed of cartilaginous tissue,
and as might be expected the cartilaginous are the most com-
mon of the benign osseous tumors. All varieties of cartilages
are found in neoplasms, hyaline being the most common, and
fibro-cartilage and reticular cartilage being rare. Eibro-
cartilage tumors are most frequently in the salivary glands
or about the ligaments.

There are two classes of chondromata, namely : those which
spring from normal cartilages or the bone, and those which
originate elsewhere. In the first case the tumor grows slowly
and resembles epiphyseal cartilage in their structure, and ai'e
usually to be found in the neighborhood of the epiphysis, an
examples of which are found in the photographs I am passing
around.

Tumors which develop elsewhere are seldom pure chon-
dromata, and often show malignant characteristics. In many
cases they appear to be left anchored upon the shaft at the
point where they first appeared, so that the tumor which first
appeared near the end of the bone is later near the middle of
the shaft, the epiphysis having grown beyond them. In some
cases it has been shown that small fragments of cartilage may
be left behind in the ends of the long bones as the epiphysis
advances, and if they remain without ossification they are
ready to form tumors later in life. This fact exj)lains the
frequent association of rickets with multiple chondromata,
for irregular ossification is often observed in that disease.

Chondromata most frequently begins in childhood, when
the bones are actively growing. It is estimated that about
two-thirds of chondromata originate from some part of the
skeleton, and over one-half of these in the hand and foot.
Chondromata growing from costal or nasal cartilages are usu-

N. C. MEDICAL SOCIETY. 553

ally small. They are also common in the jaws. Chondro-
mata have been found in subcutaneous tissue. Chondromata
found in the ischio-rectal space, testis, breast and parotid are
seldom pure, and usually a part of the mixed tumors in the
salivary glands are associated with sarcoma. Misplaced
foetal remains are described as a cause of pure chondromata
in these regions. Those in the parotid have been derived
from the bronchial clefts or the ear. Chondromata are fre-
quently multiple, and in rare cases they are seen in great
numbers, distorting the limb and jaw, displacing the eyes and
producing such defonnities which not only render the patient
helpless, but may terminate in death. They grow without
pain or other symptoms, only as may be caused by their bulk
or pressure. They interfere with parturition when found in
the pelvis. They may cause spontaneous fracture to occur in
the shaft of the long bones which become atrophied by pres-
sure of the tumor. When they produce inflammation ne-
crosis and sloughing frequently follow. Chondromata may
undergo gelatinous softening and become cj'stic ; they also be-
come sarcomatous in many cases, but they are more liable to
calification and ossification. After injury to the bone chon-
dromata develops with great rapidity, and on their removal
they may return, finally undergoing sarcomatous degenera-
tion and form secondary tumors in other parts of the body.
The true chondromata, growing from the bone, are rarely
seen as secondary deposits in the lymphatic glands and in
the lungs. So-called mixed tumors contain cartilaginous tis-
sue. Chondromata are usually small, although not Incapable
of attaining a huge size. They are fixed to their parts of
origin, but without attachment to the surrounding parts. The
overlying skin may be unaffected for a long time, but ulti-
mately become ulcerated and a sinus is established, communi-
cating with the breaking down tumor mass. They form hard,
smooth, round or lobulated masses. It is often impossible to
make a diagnosis between ossification and chondromata of
the epiphysis, but examination by the needle will be of great

554: riFTY-FIFTH ANNUAL SESSION

advantage as the point will penetrate the chondroma, but not
the ostema. The majority of these tumors require no treat-
ment, but they should be thoroughly eradicated if an opera-
tion is attempted. If the base is thoroughly gouged out in
the pedunculated variety they will not return. Amputation
is the only remedy for those of broad bases, sometimes en-
circling the bone or originating in the centre. Chondromata
which arrive independently of the normal cartilages usually
grow slowly, but are subject to malignant change ; and when
they occur in the parotid they should be removed unless there
is great danger of injury to the facial nerve. Softening and
rapid growth indicate malignant change and the necessity for
radical treatment, which should consist of complete extirpa-
tion, not merely enucleating the tumor out of its capsule.
When chondromata occur in the upper jaw, on account of
their liability to recurrence and finally undergoing malignant
changes, the bone should be sacrificed at the first operation.

History. — Patient, a young boy fourteen years old. Had
had measles, scarlet fever and whooping-cough in childhood.
Father and mother living; family history negative. Case
was first seen by Dr. A. S. Whittaker, of Biltmore, who ad-
vised him to consult a surgeon.

At the age of seven years his parents discovered a bent con-
dition of the bones of the fore left arm, carrying the hand
outward. At the time of the discovery of this deformity
they observed some very small tumors coming on the fingers
of both hands. On account of the position of the hand and
forearm and the appearance of the fingers they imagined that
it resembled the foreleg of a turtle, and was caused by the
mother getting frightened at a turtle during pregnancy. These
tumors involved fingers and thumb on both hands, and toes on
both feet ; however those on the feet were of small size. They
grew slowly and gave no pain.

At the age of thirteen the tumors on the little finger of the
left hand began to grow very rapidly and gave the patient
some pain. Strange to say the boy continued to work, but as

N. C. MEDICAL SOCIETY. ODD

a necessity, as the parents were very poor. One day while
chopping wood a small piece flew up and struck him on this
enormous growth, causing an abrasion which never healed.
This accident occurred just two months prior to the time I
saw him.

There were two large sinuses, as shown in the picture, dis-
charging an offensive sero-sanguinous fluid. The tumor was
so heavy that he had to carry his hands crossed over and sup-
ported by the other arm. He could not raise it to right-angles
of the body without assistance. He was very ansemic and
was losing weight rapidly. His pulse ran from 120 to 130,
and his temperature from 101 to 102. I placed him in the
hospital for operation the next day. He had had two or three
small hemorrhages recently from the sinues of the tumor, and
while the nurse was scrubbing the arm, preparatory for the
amputation, there was a sudden and profuse hemorrhage that
required quick action to save him from bleeding to death. My
diagnosis was multiple chondromata, undergoing sarcoma-
tous degeneration, and the microscope showed it to be a giant
cell sarcoma. I amputated above the elbow and the boy left
the hospital in ten days. I placed him on an alterative tonic
treatment. There seems but little tendency of the chon-
dromata to grow on the other hand and the feet. It is now
two years since the operation occurred and no signs of ma-
lignancy have occurred. He is in apparently excellent health.

The points of interest in this case are: the extensive in-
volvement of the bones of the fingers and toes, the malignant
degeneration of a chondroma, and the advanced stage of the
malignancy in these days of progi'essive surgery.

556 FIFTY-FIFTH ANNUAL SESSION

LIGATIO^^ OF THE FEMORAL ARTERY. RESULTS.

BY J. R. PADDISON, M.D., OAK RIDGE, N. C.

In the j)resentation of this clinical case to the Society I do
so not because of any specially wonderful feat having been
performed, but purely because of the very great iufrequency
of this class of cases, and because of the doubtfulness of the
final results.

Surgical Anatomy of the Femoral Artery. — I shall briefly
refer to the anatomical features of the femoral simply to re-
fresh the minds of many who like myself are not surgeons,
and therefore become "rusty" on anatomy:

(a) Position of this blood vessel is best outlined by a line
drawn from a point midway between the ant., suf. spinous
process of the ilium and the symphysis pubes to the prominent
tuberosity on the inner condyle of the femur, having the leg
slightly abducted and rotated outward. The upper two-thirds
of this line lies over the course of the femoral.

Practically speaking the femoral in the upper half of its
course lies in Scrapa's triangle and in the lower half of its
course is found in Hunter's canal.

(b) The blood vessel is divided, for convenience sake, into
the common femoral, that portion corresponding to about the
first two inches below Poupart's ligament, and the superficial
femoral which is a continuation of the common femoral.

The largest branch given off from the femoral is the pro-
funda ; its point of origin usually being on the outer side of
the femoral from one to two inches below Poupart's ligament,
and this vessel is of special significance when we are con-
sidering the question of ligating the parent trunk.

Report of Case. — Early in the morning of December 18,
1907, I had a "hurry call" to see patient in question. Was
informed that patient had been accidentally shot by a dyna-
mite cap, and was perhaps already dead from loss of blood,
unless from some cause he had stopped bleeding. Luckily for

N. C. MEDICAL SOCIETY. 00*

tlie patient the hemorrhage had ceased, due, I think, to the
very small surface wound which was so small the blood was
dammed back into the surrounding tissues, and firm pressure
was brought to bear upon injured vessel by the formation of
a firm coagulum. In other words, nature saw if she waited
for the doctor the patient would be a ''goner," so promptly
set to work and applied sufiicient pressure to stay the hemor-
rhage.

History of Case. — K. P., age twenty years ; white. Occu-
pation, cook at a lumber camp. Family history, etc., of no
importance. I learned that patient had thrown a piece of
paper which contained a dynamite cap into the stove to kindle
the morning fire. As soon as the fire blazed up the cap ex-
ploded, a portion of same entering patient's thigh squarely
over the femoral and two inches below Poupart's ligament.

Hemorrhage had been very profuse, and patient showed
signs, though slight, of shock ; yet I found pulse really better
than I had anticipated.

Upon examination of wound I found a small opening at
the point above mentioned. The piece of brass had ranged
slightly downward and inward, and because of the irregular
outline of piece of brass it had caused more or less laceration
of subcutaneous tissue.

The immediate and surrounding tissue was ecchymotic and
distended. Considering the profuse hemorrhage, the danger-
ous locality of wound, the absence of hemorrhage at present
time and the comparatively good condition of patient, I de-
cided upon the following course: (1) Bandage limb com-
fortably and have patient remain absolutely quiet until my
return; (2) to have an older and wiser head in consultation
with me upon my return.

At 2 p. m., about eight hours after injury, I returned to
my patient and was met there by my esteemed friend. Dr. H.
T. Bahnson, of this city. After going over the case thor-
oughly we decided to open up the wound. First, to ligate
any important blood vessel, if need be, to prevent subsequent

558 FIFTY-FIFTH ANNUAL SESSION

hemorrhage ; and, secondly, to remove the piece of brass which
had caused the trouble. We cut down over the femoral, mak-
ing an incision about three inches long, and our findings were
vastly more than I had anticipated, for I hardly expected an
injury to the femoral because I did not believe this vessel
could be opened and yet there be a spontaneous cessation of
the hemorrhage. We had hardly started through the firm
coagulum when it seemed we had struck an everlasting spring
of bright red blood, but knew only too well that this spring
would last but a very short time unless stopped quickly. Both
Dr. Bahnson and I worked like Trojans for a few moments
under very great difficulties and disadvantages, for our field
of operation was simply obliterated by the profuse outpouring
of blood. However, by strong pressure upon femoral under
Poupart's ligament, the hemorrhage was stayed until the field
was somewhat cleared, and the femoral securely ligated about
two or two and one-half inches below Poupart's ligament.

The loss of blood had been gi'eat and the patient was mani-
festing this fact. The anesthetic was discontinued ; the
wound swabbed out with pure alcohol, no further search being
made for the bit of brass in the tissue, and the wound quickly
closed. The usual line of treatment was given patient to over-
come shock. I instructed his nurse to keep the limb warm
with hot blankets and hot water bottles if need be. Patient
began improving and was able to be out in about ten days.
Collateral circulation was rapidly established, I presume, the
patient never complaining of anything but a slight numbness
of limb for a few days. The patient tells me that he suffers
no inconvenience whatever with the limb.

This case presented many surprises to me, but none greater
than the one of last week when I examined the case for the
first time since the patient was discharged. To my surprise
I could detect no pulsation on injured side at Poupart's liga-
ment. Continuing the examination I could easily trace a
round cord from point of ligation upward to Poupart's liga-
ment, which I believe is nothing more or less than the ob-
literated femoral.

N. C. MEDICAL SOCIETY. 559

Well, where does he get his circulation for that leg, did you
say ? Maybe the Lord knows ! I am quite sure I don't, unless
this is one of those cases in which the profunda arises ab-
normally high, or unless the collateral circulation is of much
more moment in this part of the body than is usually thought.

In conclusion, I wish to say, gentlemen of the Society, that
the case is to me very unique and has caused me to ponder
and wonder many times ; and while I am not able to clearly
figure out all the points in the case to my entire satisfaction,
would like to say I will feel amply repaid if the report of this
case, in this simple manner, will at any future time be of any
aid and assistance to a brother physician when dealing with
the subject of femoral ligation.

560 FIFTY-FIFTH ANNUAL, SESSION

ENDOAl^EURISMOREHAPHY.

BY THOMAS M. GREEN, M.D., WILMINGTON, N. C.

Dr. Rudolph Matas, of New Orleans, first called attention
to the operation of endoaneurismorrhaphy, or intrasacciilar
suture of the blood vessel orifices entering an aneurismal sac,
as a distinct method of treating aneurisms, at the meeting of
the American Medical Association in Albany, 1902. He re-
ported at that time five cases vt'hich he had operated on by
that method.

His first use of the method of intrasaccular closure of the
orifices entering the sac was in 1888, by operating on a bra-
chial aneurism, being forced to abandon the attempt at total
extirpation of the sac, owing to the danger of injuring the ulna
and median nerves which were incorporated in the walls of
the sac.

In 1906 he again reported at the fifty-seventh annual ses-
sion of the American Medical Association thirty-four cases
operated on by this method, by twenty-one American opera-
tors. There seems to have been a great deal of confusion as
to just what the operation consists of. Matas divides the pro-
cedures, according to the character of the aneurism, into three
classes :

1. The obliterative endoaneurismorrhaphy, which consists
in opening the sac freely, turning out the blood clots and su-
turing all the orifices entering the sac, thus securing perma-
nent hcmostasis and permanently stopping all access of blood
to the sac. The walls of the sac are enfolded upon themselves
so as to obliterate the cavity. Indications for application of
this method are all aneurisms in which the sac is of a fusi-
form type, in which there are two or more orifices of supply
and in which the parent artery is entirely lost as the seat of
the aneurismal sac by blending with the walls of the sac
through its circumference.

X. C. MEDICAL SOCIETY. 5G1

2. Eestorative endoaneiirismorrhapliy is solely applicable
to the sacciform type of aneurism, in which the parent artery
retains its normal continuity and outline, with the aneurismal
sac apparently engTafted upon it and communicating with it
by a single orifice. In this type the sac is opened, clots re-
moved and washed out, and the opening from the sac into the
parent artery is exposed. The sutures are placed so as to pene-
trate all the coats of the sac at the margins of this orifice. The
flow of blood into the sac is thus permanently prevented and
the lumen of the parent artery remains patulous, the arterial
stream being deflected through its normal course. The sac is
then obliterated as in the preceding method.

3. The reconstructive endoanuerismorrhaphy consists in
reconstructing the vessels from the walls of the aneurismal
sac, and is applicable only in those forms of fusiform aneu-
rism in which the coats of the sac are firm, elastic and resist-
ant, and the two openings, one above and one below, leading
into the main artery lie on the same level in close proximity,
and are situated at the bottom of an easily accessible aneuris-
mal sac. This is accomplished by inserting a small rubber
catheter into the two openings of the vessel and suturing the
sac over this. The catheter is removed before the last stitches
are tied ; leaving behind the reconstructed channel of the ves-
sel corresponding to the outline of the normal channel. The
orifices of any collaterals entering the sac may be sutured if
they be present, and the sac then enfolded on itself as in the
preceding methods. It is perhaps rare that we find aneuris-
mal sacs that are amenable to this form of treatment.

Matas, in his last report at the recent meeting of the Ameri-
can Medical Association in Chicago, reports eighty-five cases
of aneurisms operated upon by his method, fifty-nine of which
were obliterative ; thirteen restorative, and thirteen recon-
structive. Since reading his paper he has discovered eight
other operations, all of which were done in Chicago, and all
of which were successful ; but I am unable to classify them, as

562 FIFTY-FIFTH ANNUAL SESSION

he gave me no further details. This would make a grand
total of ninety-three cases operated on in six years.

However, I shall not include the last eight cases in the fol-
lowing discussion, for a lack of detail. The eighty-five opera-
tions above referred to were performed by fifty-two different
operators, forty-nine of whom were Americans, representing
nineteen States; and three of whom were foreign surgeons.
representing Canada, Spain and Italy. IsTor does this list
include arterio-venous aneurisms. In the eighty-five cases
there were seventy-eight recoveries and seven post-operative
deaths.

Dr. Matas, in referring to these seven deaths, does not think
that more than two of them should be charged to the operative
procedure, or at least as direct post-operative sequence; thus
his mortality would be reduced to 2.3 per cent. Secondary
hemorrhage occurred in 2.3 per cent; gangrene in 4.6 per
cent.

Upon investigation of the bad results he finds that, in most
of them, it was attributable to inexperience with the method
and bad judgment in the operative procedure.

Of these eighty-five cases the anatomical distribution was
as follows:

Abdominal aorta

External Iliac

Gluteal

Ilio-Femoral

Femoral

Popliteal

Posterior Tibial

External Carotid 1

Subclavian 1

Subclavio-Axillary 2

Axillary 1

Brachial 2

Total 85

Relapses occurred only in the reconstructive cases : four in
thirteen cases, or 28.09 per cent. In one of these the aneurism
was cured by a secondary obliterative procedure, and in two
of the other three it could have readily been effected in the
same way. In only one case were the local conditions un-
favorable for secondary obliterative procedure.

The feature of this operative procedure which appeals to
me as most important to the successful carrying out of one of

N. C. MEDICAL SOCIETY. 563

the three methods just described, is that of procuring com-
plete hemostasis before attacking the aneurismal sac, and this,
while simple, when the aneurism is situated in the extremi-
ties, permitting the use of a tourniquet, becomes a very seri-
ous problem as we approach the root of the limb, or the neck,
for it is not only the temporary ligature of the vessel Irom
which the aneurism springs above and below the sac, but the
control of the collateral circulation to the sac, which is de--
sired as well. A surgeon must seek the large arterial channel
well above the aneurism, which supplies the entire field, and
here apply his temporary ligature. He is then enabled to oc-
clude the entire source of blood supply to the sac, and spares
himself the horror of a most formidable and sometimes fatal
hemorrhage from these collaterals to the sac upon incising the
aneurism. This applies, especially, in the ilio-femoral, iliac,
axillary, brachial and subclavian aneurisms. In carotid
aneurisms one has further to consider the secondary effect of
blood supply by collateral cii-^ulation to the brain. Here it is
best to test the efficiency of the collateral circulation before
attempting any operative procedure. Indeed, that is one of
the great questions to decide before attempting any operative
procedure upon any aneurismal sac, and especially so in the
old or sclerotic subjects. We must have some method of oc-
cluding the blood to the sac for forty-eight hours in order to
enable us to decide whether there is sufficient collateral circu-
lation or likelihood of such being established, and that our
operative procedure will not be followed by gangrene of de-
pendent parts. Among the methods for furthering this inves-
tigation are the aluminum bands of Halstead, Criles clamps,
and the protected ligature of Jordan and Doberauer.

Matas, himself, has suggested a simple silver wire baud
with a metal clip to hold the wires together in parallel roads.

There still remains the danger of embolism upon the re-
moval of any of these devices. Matas suggests that the de-
termining of the blood pressure in the very tips of the ex-
tremities after compression of the main trunk above the aneu-

564 FIFTY-FIFTH ANNUAL SESSION

rism may prove the final solution of the problem; that is, if
the manometer show a more or less sustained peripheral
blood pressure an operation is justifiable. If, however, the
manometer registers zero, we have a positive indication of
want of collateral circulation, and a positive contra-indica-
tion for any operative procedure.

Summary.

It is my belief that the intrasaccular method of treating
aneurisms, when judiciously applied, offers the best results
of any operative procedure. The obliterative operation is far
superior to any method of ligature, for the reason that we
permanently close all the openings entering the sac by sight,
and permanently obliterate the sac itself, while at the same
time it evacuates the contents of the swollen sac and relieves
the oedema of the limb, thus bettering the chances of estab-
lishment of collateral circulation to the parts below. The liga-
ture method often fails, because it does not control the col-
laterals to the sac.

That it has a distinct advantage over the method of liga-
ture with total extirpation is obvious, because it does not
interfere with that collateral circulation to the parts below,
which has been more or less already established, or to the es-
tablishment of collateral circulation later.

Again, it is often most difficult, indeed impossible, to dis-
sect an aneurismal sac free from the neighboring veins and
structures, without permanent injury to them.

The advantages of the restorative operation are more
brilliant still, since it leaves a blood channel in its normal
condition. There is no method of treatment of a saccular
aneurism which can be compared to the restorative operation.
Matas says that is an obligate surgical procedure.

The question as to the advantages of the reconstructive
operation is still in its infancy, and offers a field of much
promise. It is hard to understand why the same original
causes operating to produce an aneurismal sac at a local
point, unless it be a traumatic aneurism, would not continue

N. C. MEDICAL SOCIETY. ObO

to be present and produce a recurrence of such an aneurism,
although a reconstructive operation was for the time sue-
cessfuL However, it may be that after all, in these cases
of the successful reconstructive operations, the success was
due, not sc much to reconstructing the vessel at the point
where the a leurism occurred, so that it could withstand the
intravascular tension, but to the fact that sufficient collateral
circulation had already been established to nourish the de-
pendent parts before the operation was attempted. At least,
sufficient blood was carried by this collateral circulation to
almost nourish the parts, and the reconstructed vessel played
a secondary part in maintaining the circulation of the parts.

This has been clearly demonstrated to my mind by the fact
that three cases were first operated on by the reconstructive
method, and later, when the obliterative method was insti-
tuted to cure a recurrence, sufficient collateral circulation to
the dependent parts was readily shown.

Halstead claims that in old and sclerotic subjects, where
there is doubt of collateral circulation being established after
obliterating an aneurismal sac, a better method would be to
apply a slow and gradual obliteration of the main trunk
above the sac, in order to permit collateral circulation to
form gradually.

If my idea of the reaction of the circulation after a re-
constructive operation is a correct one, why then shouldn't
such an operation, which does not occlude, but largely pre-
serves the lumen of the main trunk while the collaterals are
forming, even though it might necessitate a secondary ob-
literative procedure, be a safer plan ? I do not wish to decry
the brilliant results obtained in those cases of reconstructive
operation which have proven to be successful, but it is well
to know whether the original channel of blood still is the
chief source of arterial supply, or whether it is acting in uni-
son with the collateral circulation, but occupying a secondary
position.

With our better understanding of the pathological be-

566 FIFTY-FIFTH ANNUAL SESSION

havior and reaction, and reparative processes of the endo-
thelial lining of the vascular system. * * *

My case in question was one of a large femoral aneurism
occurring in an octoroon, age forty-six, in whose history we
could find nothing of interest bearing on his condition. The
pliysical examination showed nothing further than an inter-
stitial nephritis, with increased arterial tension. The aneu-
rism was about the size of a large orange, extending from
the begmning of Hunter's Canal upward in Scarper's tri-
angle; fusiform in type. Complete hemostasis was secured
with a tourniquet, and the sac incised throughout its length.
It was found to have two openings : one above, one below ;
not suitable for the reconstructive procedure because thes.'
openings gradually merged in a funnel-like manner into the
walls of the sac ; the walls of the sac being thin and friable.
I therefore closed both openings with catgut suture, and
drained the sac with a cigarette drain, without enfolding
its walls. My object in so doing was to save as much time
as possible, owing to the man's general condition; and fur-
ther, to the fact that the sac walls were so friable that the
stitches placed to bring about enfolding would not hold. Re-
covery was uneventful, pulsation in the dorsalis pedis artery
being apparent at once, showing that it had been established
previous to the operation, and in forty-eight hours it was
apparent in the posterior tibial. The patient is now up and
at his occupation as a steward on a river boat.

I am much indebted to Dr. C. IT. Lavinder, of the Marine
Hospital Service, of Wilmington, IST. C, through whose
kindness this case was referred to me ; and especially am I
indebted to Dr. Rudoph Matas for a copy of his manuscript
which he read at the recent meeting of the American Medi-
cal Association in Chicago. Indeed, this effort is largely a
repetition of his various communications upon this subject
in the past six years.

jst. c. medical society. 567

AESCESS OF THE BRAIN. •

BY R. G. BUCKNER, M.D., ASHEVILLE, N. C.

Abscess of the brain is a focal suppurative inflammation
of either or both the grey and white matter.

Etiology. — It is always secondary and dependent upon
the intracranial invasion of micro-organism from remote
sources ; any one of the pus-producing micro-organisms being
sufficient cause. It may occur at any age, but it is more fre-
quent in the second and third decennial, and is very rare in
very young children and in old age. It is from three to five
times as frequent in males as in females. It is associated,
first, with local cranial suppurations ; second, with injuries
to the head ; third, with certain general infections ; fourth,
with certain local diseases in other parts of the body.

According to N'ewton Pitt nearly half of all brain ab-
scesses are associated with cranial suppuration, and nearly
all of these are due to middle-ear disease. Chronic otitis
media is by far a more common cause than the acute form.
Jansen's analytical study of several thousand cases estab-
lished the fact that the proportion is more than six to one;
other observers have put it four to one. Other cranial sup-
purations sometimes followed by abscess in a causative rela-
tion are to be found in the frontal sinus, the ethnoid cells, tlie
antrum, the orbit and the nose and throat. Practically all
cases occurring in very young children are due to trauma
or middle-ear disease.

L. E. Holt, in the Archives of Pediatrics, March, 1908,
gives the following study of thirty-two eases:

1. That abscess of the brain in children under five years
is rare; (2) that the principal causes are otitis and trauma-
tism; (3) it rarely follows acute otitis, most often neglected
eases, and is surely secondary to diseases of the petrous bone;
(4) in the cases occurring in infancy, without evident cause.

568 FIFTY-FIFTH AIN^NUAL SESSIOX

the source of infection is probably the ear, even though there
be no discharge; (5) the development of abscess after injury
to the head without fracture of the skull is extremely rare.
In nearly all the traumatic cases definite cerebral symptoms
show themselves within the first two weeks after the injury.
In cases of falls as remote as several months there is prob-
ably some other cause as a latent otitis.

Among the general infections most liable to become com-
plicated with abscess of the brain are pyemia, tubercle, in-
fluenza, enteric fever, variola and erysipelas. Since pyemia
is well on its way to becoming extinct, it is not so frequent
a cause.

"It is of gTeat interest that cases of abscess of the brain
have been met with apart from any other microscopic intra-
cranial tubercular lesions which have yielded pure cultures
of the tubercle bacillus" (Ballance).

Dr. Bristow in 1891 published two cases following in-
fluenza without middle-car disease. Among local diseases
in other parts of the body is putrid inflammation or gan-
grene of the lungs, suppurating cervicle glands and foci of
suppuration of the liver, fallopian tubes, and at the seat
wounds. An instance illustrating the last is reported by
Surgeon-General Turner, IT. S. A., in the Neiu YorJx- Medical
Journal, March 14, 1891, of the sudden death of a soldier
who was considered to be in perfect health, the autopsy show-
ing a multiple abscess of the left frontal lobe; the man at
the time of his death was reclining on a bench reading a
newspaper. A few weeks previously he had received a gun-
shot flesh wound of the arm in an engagement with robbers,
which had healed readily, the bone not being injured. The
abscess could not be traced to anything other than the injury
of the arm, though there was not a single symptom, mental
or physical, suggesting its presence.

Brain abscess occurring after gangrene of the lung has
been observed and recorded at least fifty years. Though it is
evident that the infection is carried in the blood stream, no

N. C. MEDICAL SOCIETY. 569

adequate explanation as to why it should be localized in the
brain has been given. In 1901 Clajtor collected reports of
fiftj-eight cases secondary to diseases of the lungs, nearly all
of which occurred in the left side of the brain. In twenty
of the cases the lung disease was bronchiectasis; in ten em-
pyema ; in nine purulent bronchitis ; in seven gangrene ; in
five tuberculous disease; in three abscess of lung; in two
pneumonia, and in two gunshot wound of the lung.

Stoll reports a case of abscess in left frontal lobe and a
cavity in the apex of the right lung two and one-half inches
in diameter.

Blotche found pulmonary pigment in the pus of a certain
brain abscess.

In reference to injuries I will only state that, except when
the instrument causing the injury has penetrated deeply into
the brain substance, the abscess is usually really a local
meningeal suppuration with particij)ation of the adjacent
brain cortex, a meningo-cortical abscess rather than a brain
abscess proper. Occasionally injury leads to chronic disease
of the bone from which a brain abscess may arise.

Pathology of Infection. — Infective processes may extend
from a focus of cranial disease to the interior by a visible
continuous ,track of diseased bone, or through a foramen or
canal for the passage of vessel or nerve, or through congenital
defect in the ossification of bone, or along the processes of
dura mater which in certain situations dip into the bone, or
by entering the circulation. In some injuries infected ma-
terial is introduced directly into the brain or the cranial
cavity, as shown by a stab culture being made. This is the
only difference in the pathology of intracranial infection in
cases of injury and disease. The infective process spreads
more or less rapidly from the spot where the dura has been
brought in contact with the infected material. Here the
dura becomes inflamed and extra-dural suppuration occurs.
This is the first state of intracranial infection, and further
extension may be prolonged on account of the great resistance

570 PIFTY-FIFTH ANNUAL SESSION

of the dura, and upon this depends the extent of the localized
extra-dural abscess. The dura may be softened and perfo-
rated immediately with only a few drops of pus collected be-
tween it and the bone. The resistance of the dura is illus-
trated I'y Bergmann's case. On April 2d a man was admitted
to the hospital with middle-ear disease. On irrigation of
the ear until it was quite free from pus the auditory canal
was rapidly refilled to overflowing, and a mastoid operation
done on March 12th. The following day when dressing and
inspecting a fistulus track was detected. This was enlarged
with a sharp spoon. There was a recurrence of symptoms.
On April 11th a free opening was made by chiseling away
considerable bone, thus freely opening the extra dural ab-
scess. From that time recovery was uninterrupted. Pus
evidently had been in contact with the dura for probably
more than nine weeks, but no perforation had taken place.
When the infection traverses the arachnoid and reaches the
subarachnoid space and the pia there will be either a localized
or a. diffused inflammation, the extent depending on the
virulency of the infection.

The infection in disease of the cranial bones is by direct
continuity in the continuous track of diseased bones. In a
rapidly extending infective process diffuse meningitis would
be the most probable result ; in the more slowly spreading
infections resulting from chronic disease the meningeal affec-
tion would be localized by adhesion, and time given for ex-
tension of disease to the brain. This is shown by the fact
that abscess of the brain or sinus infection is a more common
complication of chronic ear disease than is acute suppurative
meningitis. In most cases of slowly spreading infection from
chronic disease adhesions occur, obliterating the arachnoid
space at the site of infection, and binding together the dura,
arachnoid, pia and cortex. The lymphatic shields of the nu-
merous small blood vessels which traverse the cortex at right
angles to its surface, are in direct communication with the
subarachnoid space, and through these as through a number

X. C. MEDICAL SOCIETY. 571

of capillary tubes infective matter easily traverses the cortex
and reaches the white substances. The cortex is very vascular
and its connective tissue element is reinforced by numerous
folds or promulgations of the pia, and abundantly supplied
with the connective tissue corpuscles ; hence it is able to offer
a strenuous resistance to the bacterial attack and does not
usually undergo any extensive destruction. Along this track,
traversed by infective material, a barrier of fibrous tissue
is formed, limiting the destructive process to the narrow
track.

The white substance is much less resistant, because it is
nonvascular, and the gi'eater the distance from the cortex the
more easily does the bacterial action cause its dissolution.
In its incipiency it presents the local appearance of what
has been described as acute red softening; the degree of red-
ness depending upon the amount of blood determining to the
point. As it advances the pus changes from a reddish yellow
to a greenish or greenish yellow color, and in some cases the
odor is quite offensive. This abscess comes to assume a mush-
room shape with stem attached to the dura at the original site
of infection from the bone. When the dura has been sepa-
rated from the bone over a considerable area, there is a
greater extent of adhesion of the meninges. Salzer success-
fully operated on a case where the tempora-phenoidal dura
was separated from the bone over an area as large as a silver
dollar, and was in a sloughy condition. The sloughing por-
tion was excised and the meninges were diffused into one
layer; the inner portion, formed by the pia, was not necrotic,
and there was no abscess of the brain.

Mannasse reported a case in which the infection had pro-
ceeded further, and there was abscess of the brain, the outer
wall over which a considerable area was formed by fused
meninges and cortex. The more recent the abscess the nearer
it will lie to the spot where the infection traversed the dura,
and the more evident will be the stalk or its remains. The
older the abscess the greater is the apparent recession from

572 FIFTY-FIFTH ANNUAL SESSION

the dura and the less evident the stalk. Thus the infection
gradually spreads into the brain substance by slow extension
in direct continuity from the spot where the disease in the
bone reached the interior of skull. Yet infective particles
may, in the brain, as in other parts of the body, be carried
by circulation to a spot remote from the site of infection.
An abscess may thus arise in the substance of the brain with-
out any visible connection with the bone disease to which it
really owes its origin. The stalked form of brain abscess
compares in its mode of formation to palmer abscess, from
which infection in an abrasion of the skin of the palm con-
tinues from the superficial area by a narrow track to a focus
of disease beneath the deep palmer fascia ; and the isolated
brain abscess has its parallel in an abscess of liver arising
from disease of the intestine.

The explanation of the pathology is not far to seek in a
case reported by Swain, in which purulent infection of the
choroid plexus in the descending cornu of the lateral ven-
tricle occurred as a result of caries of the tegmen tympani
of the same side, the intervening brain substance being un-
affected. In rapid increase of the abscess it may lead either
into the ventricles or on the surface of the brain.

Encapsulation of abscess in the brain is thought to be rela-
tively more frequent than in other parts of the body. The
pathological process is the same, but the peculiar liquid tex-
ture of the brain allows a sharper differentiation between
the hard tissues forming its wall and the surrounding un-
altered brain substance. Acute brain abscesses are some-
times encapsulated, and nearly all chronic abscesses are en-
capsulated.

In a case of cerebellar abscess, with symptoms pointing
to a duration of at least eight months, no capsule is found,
but the whole cerebellar hemisphere was nothing but a shell
of softened gray matter. As in other parts of the body the
latent abscesses may slowly extend and give rise to slight
sym]itoms extending over a considerable period, and encap-

N. C. MEDICAL SOCIETY. 573

suled. A slowly growing abscess may be regarded as push-
ing aside fibers passing from the cortex to the internal cap-
sule, rather than destroying them. This inference is sup-
ported by the fact that recovery from paralysis takes place
after successful drainage of the abscess, yet it should be re-
membered that cortical impulses may find new paths.

When an abscess is drained through the stalk, as in the
case of tempora-sphenoidal abscess opened through the teg-
men, though it may be large, there may be but little actual
damage to the cortex. A thick capsule does not prevent the
abscess from extending, nor even from leaking into the ven-
tricle. It is a fact, also, that acute inflammatory softenings,
or even suppurations, have been known to arise around an
encapsuled abscess. Abscesses in thick capsules, which can
be shelled out whole, have run a chronic course. Complete
encapsulation of the stalk form does occur, the narrow track
of communication being obliterated by scar tissue. In such
cases the capsule was found to be adhered to the bone.

When an abscess is found in the brain completely isolated
and at some distance from the meninges the infective organ-
isms have been carried by the blood or lymph stream, and have
multiplied at a spot some distance from the original point of
infection. Many such cases have resulted from injury with
out bone disease, a considerable number having followed gun-
shot wounds. The complications usually found are phlebitis
and thrombosis of the lateral and the superior petrosal sinus,
lepto-meningitis, extensive meningo-encephalitis and purulent
pachy-meningitis, lepto-meningitis and sinus thrombosis being
especially common in cases of aural disease.

Streptococcus pyogenes albus, staphylococcus cereus flavus,
and the bacterium vulgarus, Charcot and Leyden cystals and
streptothrix have been found in pus from cerebral abscess.

Spontaneous recovery in certain tubercular cases has been
claimed by competent observers. Inspissation, and even cal-
cification of the brain abscess has been observed, but only in
tuberculous cases. It is stated by Ballance that cases are

574 FIFTY-FIFTH ANNUAL, SESSION

relatively common in early life, which either get well or run
a chronic course, extending over many years, and then die
from distention of the ventricles ; and the only explanation
of the symptoms can be given by inferring the presence of
cerebral tumor, or of meningitis. In these cases it seemed
probable that there was a local tuberculous mass in the brain
from which recovery had come. In one such case, some four
years after a diagnosis of cerebral tumor had been made, the
autopsy showed great distention of the ventricle. There was
no visible tumor and no evident trace of tubercle in the brain.
But in the mesentery there was a large calcareous mass.

Two girls under twenty years of age, both suffering from
headache, vertigo, mystagmus and repeated purposeless vom-
iting; both had double optic neuritis, unsteady gait, and ab-
sence of the patellar reflex. The diagnosis in both cases was
some affection below the tentorium, probably tumor ; both
made good recoveries, but in one some impairment of sight
remained.

Abscess of the brain is commonly single. MacEwen says
93 per cent of abscesses from injury are single. In pyemia
they are usually multiple. A second abscess occurs in the
frontal and occipital lobe occasionally, and even more often
in the tempora-sphencidal lobe.

Symptoms. — These may be broadly divided into general
and focal symptoms. Among the former are headache, photo-
phobia, slow cerebration, slow pulse, subnormal temperature,
occasional chills, foul breath, deathly pallor of the skin, con-
stipation, facial palsy of the peripheral type, optic neuritis,
impaired vision, conjugate deviation of the eyes, stabile pupil,
mystagmus. The mental state is very likely to be mistaken.
In order to estimate exactly it is well to know the mental
capacity of the patient. A condition of excitement and talk-
ativeness in a person who is reserved and stolid is of much
more importance than in an excitable and loquacious indi-
vidual. Also apathy and stupor in a man of bright, active
intelligence is of greater diagnostic value than in one who

]Sr. C. MEDICAL SOCIETY. 575

is dull and stupid. These variations in the mental state are
observed also in a sinus thrombosis, meningitis and tumor.

Headache is a variable symptom, there being few cases
recorded in which it was never noted, and other cases in
which it was not a very marked symptom until late in the dis-
ease, and still other cases in which it occurred at different
times, but was never severe, and still other cases in which it
was the chief symptom.

The course of the temperature is also quite variable. Mac-
Ewen points out that it is common in abscess of the brain to
find a persistently low temperature with little variation, and
that during the preliminary period it is usually slightly above
normal. During the period of full development of the ab-
scess it is about normal, or slightly subnormal, from 97 to 99
F. ; and in the terminal stage if the abscess burst the temper-
ature rises within a few hours in a bound to 105 F. ; but if it
is evacuated by operation it rises to about 101 F., and in a
few hours falls below 100 F., remaining around normal until
recovery. Okada found a marked rise of temperature and
febrile course in forty-six out of eighty-eight cases of abscess
of cerebellum. In fifteen the temperature was normal, and
in fifteen it was subnormal. In eight there was a rise of
temperature only at the onset, and in four only at the very
end.

Rapid emaciation, the cachectic appearance, with sallow
skin and evidences of the septic state, and other above-
described symptoms, suggest latent abscess.

Optic neuiitis is a valuable sign when taken with other
symptoms. In Okada's cases, two-thirds of his patients had
optic neuritis in one or both eyes. In groups reported by
other observers, it occurs in 30 per cent of the cases, but it
occurs also in brain tumor, meningitis and sinus thrombosis.

The following localizing symptoms should be taken into ac-
count : motor aphasia, optical aphasia, hemianopsia, hemian-
esthisia, and weakness of the arm and leg, vertigo, ataxia,
with purposeless vomiting, lying ]irone on the side of the
lesion, or falling tov/ard the side of lesion, etc.

576 FIFTY-FIFTH ANNUAL SESSION

Careful observation and record of the case for a sufficient
period of time should be made. In this way an undoubted
diagnosis may be made in most cases. Yet a few diagnoses
will remain to be made post-mortem. There is wide differ-
ence in the clinical course of cases on account of the suppura-
tive process varying within the wide limits in its virulency
and local destructive effects. Five types of clinical evolu-
tion have been described by French authorities :

1. A subacute evolution more or less distinctly divided into
three stages, with an initial febrile state characteristic of septic
infection; headache, vomiting and fever. This stage may
be confused with specific fever. It lasts a variable number
of days, and is the stage of suppuration. The second state is
that of remission. Sometimes suddenly but more often grad-
ually, the symptoms abate and give place to a calm which is
deceptive and prolonged; and during this stage there are few
or no manifest symptoms. Yet, when the abscess is in the
cerebellum ,there will be some emaciation and impairment
of the general health, and thorough examination would reveal
some patliognomonic localizing sign. The third, or paralytic
stage supervenes suddenly, with or without convulsions. This
may pass into profound coma, terminating fatally in a few
hours, or recovery from the convulsive seizure may take the
place of symptoms localizing the lesion. With the onset of the
third stage there is generally a rising temperature. The
rapidly fatal cases are usually from rupture of the abscess.
The others have a more or less rapid extension of the suppu-
ration. (See Organic Nervous Diseases, by Starr, page 571,
describing case of middle ear disease.)

2. Evolution with Severe General Infection. — These cases
are rapidly fatal, the abscess symptoms being merged into
those of grave general infection. High fever and delirious
mania are prominent symptoms.

3. Evolution with Complete Latency Until the Final Ai-
tacJc or Coma. — The patient dying suddenly or in a few hours,
and an abscess that has existed usually for a long period is

N. C. MEDICAL SOCIETY. O i i

found at the autopsy. In some such cases death is absolutely
sudden. The abscess in such cases may be found in the
frontal lobe or in the outer region of the occipital lobe, and
even more frequently in the right temporal lobe. In these
silent cases an examination of the optic nen^e head, the field
of vision, and the action of the muscles of the eye has revealed
the gravity of an illness which has been regarded as trivial.

-i. In the fourth type of clinical evolution, the course is
just like that of brain tumor.

5. The fifth type of evolution is remittent, the course being
in two acts. The first is marked sometimes by headache and
fever, sometimes by an attack of mania, and sometimes by
acute delirium ; then all quiets down and the patient seems
cured ; but after a few weeks or months, or even a year, there
is a recurrence of symptoms w^hich is quickly fatal. Bris-
tow's influenza cases, previously referred to, are examples of
this type of evolution. In localizing the abscess the position
of the injury causing, or the cranial suppuration from which
it originated, have some bearing.

Unilateral spasms, paralysis, hemianopsy, and aphasia are
important symptoms in determining the exact location of the
abscess. In locating temporal abscess a certain form of
aphasia that has recently been observed promises to be very
helpful. The memory centers for hearing are located in the
first and second temporal convolutions. The relative degree
of development of these vary in individuals of different de-
grees of education. The memory centers of sight are located
in the angular gyrus and calcarine fissure. The centers in
these two areas are connected by association fibers passing
through the white matter beneath the cortex. Deep abscess
in the left temporal lobe destroys or displaces these fibers,
preventing communication. If you say the word knife, the
patient can repeat it, but can not form any notion of what it
represents any more than from a word of a foreign language.
If you show him a knife he can say it is what you cut with,
but he can not recall the word knife. This is called optical
37

578 FIFTY-FIFTH ANNUAL SESSION

aphasia, or intercortical sensory aphasia. By this symptom
diagnosis of abscess in the left temporal lobe was made and
verified by operation. In any suspected case this symptom
should be looked for, but it is useful only in locating the
abscess on the left side of right-handed people, and in the
right side of left-handed people.

Conjugate deviation of the eyes shows irritation when to-
ward the side of the lesion, and paralysis when from the side
of the lesion.

Diagnosis. — The diagnosis of brain abscess may be made
without great difficulty in ordinary traumatic cases, for there
is history of the injury and the exact location and develop-
ment of a series of cerebral symptoms pointing to localized
disease in the brain. Nervous symptoms coincide with the
location of the wound, and the localization of the cerebral
disease, and the existence of the abscess is reasonably certain.
When there is no history of an injury the diagnosis is more
difficult, because acute tuberculosis gives the same symptom
complex. Cases of brain abscess from otitis media must
sometimes be distinguished from meningitis and thrombosis
of the lateral sinus. The relative frequency of these con-
ditions are not far from the same.

Poulen collected thirty-six cases of cerebral complications
of ear disease. Thirteen of these were abscess, twelve were
thrombosis, and eleven meningitis. In meningitis there is
usually a more rapid onset and progress of the symptoms than
in abscess. The headache is more severe. There is hyper-
esthesia to sound and light and touch all over the body, these
being absent in abscess, the temperature is high and rarely
ever goes below normal. The pulse is rapid, irregular and
intermittent. There are occasional twitchings of the limbs.
or slight convulsions; strabismus appears early, trismus is
common, pain and rigidity of the neck are present, micro
organisms are to be found in the cerebro-spinal fluid.

In thrombosis of the lateral sinus there will be high fever
with septic variations in range, and frequent chills. In the

N. C. MEDICAL SOCIETY. 579

course of tweuty-four hours the temperature may twice sink
below normal and rise to 105 F. The pulse is rapid and
irregTilar, but not intermittent. There may be tenderness,
swelling and oedema over the mastoid, and oedema of the neck.
The jugTilar vein may stand out as a hard, blue cord on the
side of the neck.

The diagnosis of abscess arising under other conditions is
never positive. The presence of a cause, and a record of
cerebral symptoms that occur in a definite series of stages
point strongly to presence of an abscess.

Prognosis. — This will depend upon the possibility of evac-
uating the abscess and draining it successfully. Sponta-
neous recovery has been recorded, but this is so rare as never
to justify waiting.

l^ecrosis and caries of the tcgiimen v/as so great in one of
two cases of tempora-sphenoidal abscess as to allow them to
spontaneously, drain freely and successfully. This occurred
just as it has done in a few cases of suppurating appen-
dix. Starr reports a collection of fifty-five cases operated.
Twenty-four were after injuries, twenty-four after middle
ear disease, and three after typhoid. Thirty-four recovered,
and twenty-one died.

In a group of sixty cases of traumatic abscess operated,
thirty-eight recovered, twenty-two died. In a collection of
one hundred and ninety-six otitic abscesses operated, ninety-
six recovered.

Deuch operated on nine cases and three recovered. Barn-
hill operated on eight cases, two of which were alive and
appeared to be cured four years afterwards, and one of the
others died of a recurrence four months after the operation.

One swallow doesn't make a summer, and even if death
followed every operation in a small group of cases, who could
have the temerity to question the true spirit of surgery in an
effort to evacuate and drain all of them.

As far back as July, 1905, Komer reported ninety-two
operations with fifty-seven recoveries, and twenty-nine cases

580 FIFTY-riFTH ANNUAL SESSION

of sinus thrombosis with forty-one recoveries. It is more
than probable that part of the cases in which recovery does
not occur, the operation had been too long delayed, or was
not sufficiently exploratory.

Tkeatment.

1. General Considerations. — An abscess in the brain should
be dealt with just as with abscess in other parts of the body —
that is, by incision and thorough drainage, and if encapsu-
lated, enucleation.

In operating the surgeon must find out as he goes its situa-
tion, and whether acute or chronic, diffused or circumscribed,
or whether there be a second one. A case of acute cerebellar
abscess, opened with relief to the symptoms, died, and at
necropsy an old encapsuled abscess was found still further in.

When the abscess is drained, the brain tissue, which is of
liquid texture, tends to fill the space, and shut off a portion
of the cavity from the point of incision.

The integrity of certain parts of the brain is essential to
the continuance of life, and places a limit to surgical inter-
ference in certain directions.

These general considerations do not affect the principles of
treatment, but have important bearing upon the details of the
operation.

2. Operation for Brain Abscess Following Local Cranial
Disease. — The operation for brain abscess should be a direct
continuation of that for the removal of the continuous track
of diseased bone through which the infection spreads. This
track must be followed through the bone to the interior of
the skull.

If after a mastoid operation, or Stake's operation for
necrosis of bone in the tympanum, the symptoms point clearly
to abscess in the cerebellum, or tempora-sphenoidal lobe, the
surgeon should work his way, in the one case from the inner,
or posterior wall of the antrum to the posterior surface of
the petrous, or through the roof of the tympanum.

N. C. MEDICAL SOCIETY. 581

Enough of the petrous and squama must be removed to ex-
pose the extra-dural abscess, or the diseased portion of dura
to which the brain abscess is attached by its stalk. By this
method it is known whether the abscess has a stalk, or is iso-
lated. This stalk is a ready-made drainage tube, and is less
liable to be closed from the liquid consistence of the brain
than one made by the surgeon, also infection of the meninges
is far less likely, as well as hernia cerebri.

In cerebellar abscess, the stalk is attached to the dura over
the sinus groove, or over the aqueductes vestibuli, or over the
internal auditory meatus. In tempora-sphenoidal abscess, it
is over the anterior surface of the petrous, most commonly
over the tegumen.

Frontal abscess is attached to the cranial wall of the sinus,
or the anterior surface of petrous.

In deep abscess following an injury the stalk is attached
over the region of the fracture. Drainage through the stalk
would remove the symptoms and tendency to death, but there
are cases that will require a counter opening, as in other parts
of the body. To do this, remove a considerable area of bone,
open the dura and pack with gauze until this area of the brain
for incision is walled off by adhesions. This avoids diffuse
encephalitis and meningitis. The area of bone removed
should be in proportion to size of abscess as determined by
probe through the stalk.

If respiration ceases the abscess must be evacuated 'in the
shortest time and easiest way, and the local bone disease let
alone for the time being.

Mr. Ballance, on two occasions, completed the operations
during the performance of artificial respiration, made neces-
sary by the first few inhalations of chloroform. Also in
another, in which artificial respiration had been in progress
two hours before he arrived. And he insists that neither
morphia nor strychnia should be administered before the
dura has been opened.

3. Discovery and Incision of Abscess. — The abscess may

582 FIFTY-FIFTH ANNUAL SESSION

burst when the dura is opened, and pus may be projected
more than two feet. When sufficient opening through bone
and dura and bone is made, palpation may show it to be im-
mediately subcortical. Incision through the cortex may be
made, with great care to avoid wounding any of the numerous
vessels. The best instniment for exploration is a sharp
pointed long, narrow knife, and it should be borne in mind
that the abscess is nearly always close to the bone disease giv-
ing rise to it. Clean cut wounds heal quickly, and it is easier
to find the abscess with the knife.

The trocar and canulla have missed the abscess, or passed
through without tapping it, or struck the capsule and failed
to penetrate it. Dupuytren, in one of his lectures, says : "In
certain cases of deeply seated fluid collections, we must incise
the dura and arachnoid and brain itself, and by this bold pro-
ceeding, patients have been saved." In the same lecture fur-
ther on he continued: "Relying also on the success of J. L.
Petit, Boyer concurs in the advice of Quesnay, and does not
fear to plunge the bistoury quite deeply into the very sub-
stance of the brain in order to evacuate traumatic effusions,
and it has fallen to my lot several times to do so with suc-
cess." Fifty years later an English surgeon wrote: "There
are few surgeons who would have the hardihood of Dupuy-
tren, who plunged a bistoury in the substance of the brain,
and thus luckily relieved the patient of an abscess in this situa-
tion." In his account of this Dupuytren says: "I incised
the dura, nothing came out; I thrust the bistoury cautiously
into the brain and there welled up immediately a flood of
pus ! That very night all the symptoms disappeared, and
the patient recovered." If the knife failed to find the abscess.
it is quite easy to find it with the finger, as a tense, abnormal
swelling, which may be opened by the knife, guided and
guarded by the finger. A second abscess may be mistaken
for the teutorium.

In two cerebellar cases, one abscess in one and two in the
other, were drained, and yet both patients died from an un-

N. C. MEDICAL SOCIETY. 583

opened, oyster-shaped abscess just beneath the cortex of the
upper surface.

Progress of the Case. — The course of brain abscess is va-
riable. The earlier the operation is done the greater the
chance of recovery. There should never be delay after diag-
nosis is made, and the operation should always be done unless
the patient is actually moribund.

The operation has been done during artificial respiration
and the patient recovered.

After the operation the patient may rapidly convalesence,
or present symptoms which will tax to the utmost the re-
sources of the surgeon. A voracious appetite is a favorable
sign.

Less than a generation ago but few surgeons ever attempted
to operate for brain abscess. During the last twenty years
recoveries achieved make the future of this field bright with
promise.

584: FIFTY-FIFTH ANNUAL SESSION

AEROSTATIC DEAFNESS.

BY W. PERRY REAVES, M.D., GREENSBORO, N. C.

Aerostatic deafness has for its etiology a disturbance of the
aerostatic equilibrium of the middle ear and its pathological
sequelae.

At the meeting of the ISTorth Carolina Medical Society last
June, I read a paper entitled, "Why is the Middle Ear a^i
Accessory Cavity of the Upper Respiratory Tract, Which
Often Becomes the Etiological Headquarters of Otitis ]\[edia
and Acquired Deafness ?" This paper is really a continua-
tion or second chapter of the other paper, discussing more
fully intermittent, remittent and continued deafness, which
terms I have used in the reverse order of the fever classifica-
tion, both in order and meaning, the fever going above normal,
the hearing below. I hope that you who are so familiar with
these terms will use the same cue and play acoustics with
me for a while instead of fevers. I am going to strike at the
basic fundamental truths of this subject, in order that we
may all reason together. It is not necessary for one to have
made a special study of otology to arrive at a logical conclu-
sion, for the fundamental truths are the same in every branch
of medicine. When we know the anatomical topography and
the physiological function, then we reason that any deviation
from the normal should be considered an etiological factor
that may produce a pathological condition.

How are we to arrive at our diagnosis, by symptoms, or in-
spection and investigation ? Both methods are essential. The
symptoms cause the patient to seek his physician for relief.
The history of these symptoms is not diagnostic, as a rule,
but should suggest that inspection and investigation of the
disturbed acoustic apparatus, by himself or a specialist, is
necessary to determine the cause ; then its removal will give
relief and hasten the day when this form of deafness will
cease to be charged to heredity, because some of their ances-

This cut shows the normal position of the
drum and ossicles. Their meehanical correct-
ness so that the incus moves the stapes at a
right angle to its long axis, permitting its free
easy and quick motion.

This cut shows the tube not ventilating'.
drum retracted and fixed, handle of mallern
pushed in, head of malleus pushed outward
aiu1 upward, the suspensory lisfament put on a
stretch. Tlie top of the incus is lifted upward
and outward with the head of the malleus.
The stapes is lifted up at Its outer part, which
pushes stapes in at the upper yiart of the fen-
estra ovalis and pulling it out below, practical-
ly locking the ossicular chain.

X. C. MEDICAL SOCIETY. 585

tors were deaf. If we find, by examination, aerostatic dis-
turbance, signs of pathological conditions, which are catar-
rhal attacks, and the etiological cause, then the diagnosis is
clear, the treatment unmistakable.

I shall treat this subject from a common-sense clinical view-
point, with report of just enough cases to make my meaning
clear, rather than give a scientific review of the literature on
the subject. I shall use the same definition of deafness as in
my previous paper, "Intermittent deafness is a temporary im-
pairment of the hearing that returns to normal when the
cause is removed." Therefore, there can not be any perma-
nent pathological lesions ; the cause is usually want of venti-
lation of the middle ear, congestion of its mucous membrane,
with or without muco-serum in the tympanic cavity.

Case 1. — Male; age, 4. Referred to me by Dr. Turner
for operation. History of symptoms for past month: Had
head and chest colds, intermittent earaches, and was at times
inattentive, which means intermittent deafness, breatlies
through his mouth at night, snores, wakes frequently, throws
cover off and gets up in bed, sometimes cries with ears ; con-
dition exaggerated when he had fresh cold, as in past week,
with two or three degrees of fever. Inspection showed drum
retracted in right ear, and distended with serum in left, nares
patulous and secreting freely, breathing mostly through tiie
mouth, V-shaped arch, right faucial tonsil large enough to
clip, left small. Investigation of digital examination of
nasopharynx, large adenoid. Have we not the three primary
conditions upon which to make a diagnosis ? Right ear drum
contracted, showing that tube is obstructed and the air is being
absorbed ; left ear drum has been retracted because of partial
or complete vacuum in the car, causing a pouring out of
serum, demonstrating, at first, an aerostatic disturbance, and,
second, a subacute catarrhal condition ; third, or etiological
cause, adenoids ; exciting cause, the changeable winter months
upon a weak constitution. Having taken the symptoms and
the work up to the etiological factor, now let us take the etio-

586 FIFTY-FIFTH ANNUAL SESSION

logical factor and check up the symptoms and see if our logic
is good. The adenoid, especially when congested, plus the
secretion in the nasopharynx makes nasal breathing difficult,
mouth breathing is necessary, and the upper respiratory tract
is functionless ; the middle ear, which is an accessory cavity
of the upper respiratory tract, must suffer for lack of perfect
ventilation; but this is not all, the adenoid, by pressure on
the fossa of Rosenmiiller may block the mouth of the tube
even during nasal breathing; added to this is the secretion
which may block the fossa and the tube, or the obstruction in
the nasopharynx may cause an active or passive congestion
of the tube, producing a catarrhal stricture, the inflammation
may even extend into the middle ear ; all three of these causes
may be active at the same time, but one generally predomi-
nates the others, partially or completely preventing ventila-
tion of the middle ear by obstructing the eustachian tube.
If complete the middle ear is converted into a closed cavity
filled with air. It is a fact beyond discussion that air im-
prisoned in a cavity in the human body will be absorbed ;
here it must produce a vacuum, because the bony walls of the
middle ear can not collapse as soft tissue would to prevent
the vacuum. Now what must happen ? The air pressure
being greater on the outside of the drum than on the inside,
the drum is pushed in or retracted, becoming fixed and less
movable, and sensitive to sound waves, at the same time fix-
ing the ossicles, making the w^hole of the movable sound-
conducting apparatus more or less stationary. This is a
typical aerosatic intermittent deafness, which can be demon-
strated by polarization or cathertization, reestablishing the
aerostatic equilibrium of the middle ear, the dram assumes its
normal position, unlocking the ossicles, the hearing improves,
and if it soon returns to normal is proof of an aerosatic deaf-
ness. Having proved that a partial or complete vacuum
existed, we now have to deal with the force of the vacuum.
All of you have used the vacuum cup to produce local conges-
tion. Nature, by absorbing the air in the middle ear, creates

Jf, C. MEDICAL SOCIETY. 587

a racimm producing congestion; this congestion produced by
a physical force equals a catarrhal mucous membrane. All
catarrhal mucous membrane has a tendency to secrete mucous,
and especially to ooze serum when aided by a vacuum, which
explains the presence of mucous and serum in the left ear.

Treatment.

Removal of cause, which by our double method of reason-
ing from symptom to etiology, then by checking back we con-
firm that the adenoids are the indirect cause, producing the
pathological and aerostatic disturbance by obstructing nasal
breathing plus its secretions and irritation of the nasopharynx,
causing outpouring of mucous or muco pus, converting the
upper respiratory tract into a condition that is best described
during an attack of cold as a physiological constipation with
a pathological diarrhoea, from whence nature expects the mid-
dle ear to be ventilated with moist, warm air.

February 8, 1908, assisted by Dr. J. P. Turner, patient in
a sitting position, anesthetic, ethyl bromide, I remoyed the
right faucial tonsil with a tonsillotome, and the adenoid wiii^
a curette. Time from the beginning of the anesthetic less
than two minutes ; bleeding stopped in less than five minutes.
Xow let us begin with the removal of the cause, and trace the
result. The upper respiratory tract again performs its phy-
siological function, because the obstruction is gone, the mucous
membrane of the nose begins to assume its physiological role,
secreting more water and less mucous, because nasal breath-
ing is our best therapeutic agent for this congested membrane,
and soon the spray will become a therapeutic relic, the water
is taken up by the inspired air, which is essential to the
lungs, the mucous will cease to be excessive and performs its
function of protection to the sensitive mucous membrane.
Now we find moist, warm air in the nasopharynx, no pres-
sure on the fossa of Eosenmiiller or eustachian tube, no con-
gestion or catarrh of the tube. The physico-physiological re-
lations of the upper respiratory tract, the eustachian tube
and the middle ear has been reestablished. The aerostatic

588 FIFTY-FIFTH ANNUAL SESSION

disturbance and attacks of catarrhal otitis ought to cease to
be. Then the intermittent earaches and deafness must dis-
appear, our patient is no longer a mouth breather or has the
sniffles, and from last report, May 4th, our patient has be-
come a good sleeper and eater, has gained six pounds in less
than three months, and has taken only one dose of medicine.
Is this not a triple reward ? The mother is allowed to sleep,
the boy takes only kitchen tonics, and the father delights in
his boy's good health. Had we not operated on this little
fellow, and if we would keep his history for six or eight
years, I believe we would have a history fitting for cases two
and three, that I will now briefly report.

Case 2. — Age, 11; female; seen first December 2, 1905.
History for past six or eight years, every winter was a repe-
tition of the symptoms found in case one. For the next six
weeks while under my care she passed through the whole
category of conditions found in case one more than once.
She would have aerostatic deafness, catarrhal otitis, drum dis-
tended,' with mucous in middle ear; by polarization and the
proper treatment of the nasopharynx could reestablish venti-
lation ; mucous would be absorbed, the hearing improved, and
in a few days we would have the same conditions to contend
with again. The mother had become very uneasy about her
daughter's hearing, throat and lungs. Her condition, in
short, expressed in a long word, was, rhino-pharyngo-laryuogo-
tracheo-bronchitis. She would frequently wake at night from
coughing. Her history was that she had suffered this way
for several winters. Knowing the prejudice of a general
anesthetic by the mother, after much persuasion, I convinced
my patient that the operation would not hurt, although feel^
ing at the same time that experience might teach her different.
January 20, 1906, with Dr. A. R. Wilson's assistance, under
cocaine and adrenalin, I removed this adenoid with one
stroke of the curette. When asked if it hurt, she said, ''You
did it so quickly that I could not tell." Later I removed the
right faucial tonsil; the left was not hypertrophied. She

N. C. MEDICAL SOCIETY. 5S9

began to improve, but was not free from head and chest colds
till late spring. The next winter, except a severe attack of
diphtheria, her condition was excellent. This winter she has
made two visits to my office during an attack of acute cold.
At no time for the past eighteen months has she had any
trouble with her ears, and her hearing is good.

Case 3. — N'ovember 24, 1906. Age, 12. Kef erred to me
by Dr. J. E. Brooks for hearing and nose trouble. The symp-
toms, pathology and etiology, I will not discuss, but show you
the adenoid ^Yhich I removed, assisted by Dr. Brooks, anes-
thetic, bromide of ethyl, and allow you to draw your own con-
clusion by comparing with case two, except to mention that
earaches disappeared, hearing became good, and general
health improved. I would not have you believe that all cases
of intermittent deafness are in adenoidean children; no age
or sex is exempt; any local or systemic cause producing an
acute or chronic nasopharyngitis may, by congestion, secre-
tion, or extension into the tube, produce a temporary stric-
ture of the tube. These conditions are often found as a
complication of colds, lagrippe, measles, diphtheria and scai-
let fever. Cases two and three were nearing the border line,
and in a few years would have reached the state of remittent
deafness, which we will now consider.

Remittent deafness is in those cases where the hearing is
always below normal, but at times from such transient causes
that produce intermittent deafness, the hearing goes below
its normal and returns to its average when the cause sub-
sides. This type of deafness is generally associated with
chronic catarrhal otitis of the hypertrophic type, which has ex-
tended from the nasopharynx through the tube, or has de-
veloped pari passu with a hypertrophic stricture of the tube.
The diagnosis requires the same steps as in the intermittent
type, plus the exploration of the eustachian tube with eusta-
chian bougies or sound. One who is familiar with the topo-
graphical anatomy of the nasopharynx and has acquired the
manual dexterity for doing this work, with an eustachian

590 FIFTY-FIFTH iNNUAL SESSION

catheter diagnostic tube bag, can easily pass the catheter
through the nose into the fossa of Rosenmiiller, then with one
end of the diagnostic tube in the patient's ear, the other in
the operator's ear, by pumping air through the catheter we
find that air passes freely through the tube into the ear and
returns, it demonstrates that the tube is patulous and we are
not dealing with an aerostatic deafness ; but should we find
that none passed into the ear, or that it passed under high
pressure and distended the drum, which gradually returns to
its position as the air is absorbed or filtered back into the
nasopharynx through the tube, then we know that we are
dealing with an eustachian obstruction. Now by applying
about three drops of 1-2000 adrenalin and 5 per cent cocaine
solution, through the catheter and blowing it into the tube
and into the middle ear if possible, we can easily complete
our diagnosis. If a congestive stricture, the solution will re-
duce the congestion, and in about five minutes air will pass
freely into the ear. If a hypertrophic stricture we will find
very little improvement, but can pass while cocainized a small
bougie or sound, then possibly one or two numbers larger,
then by pumping air under one to two pounds pressure we
find that the tube is open and that the air hits the dnim at
one gush and sounds as if a small shot hit the drum. If the
ossicles are free and easy the hearing will improve at once ;
but if the joint from catarrhal otitis be stiffened, the hearing
may be worse for a few minutes and not at its best till one
or two hours. The fluctuation of the hearing is a favorable
sign, because it demonstrates that the trouble is in the middle
ear and not the internal ear. Should the obstruction be an
organic stricture from the cicatricial contraction of the hyper-
trophic connecting tissue the eustachian bougie will meet
with a resistance like a solid substance and not push through
as in the hypertrophic type. Experience alone can teach
one the proper interpretation of touch to have the assurance
that the bougie is in the tube and not gone astray into the
tissue, and frequently we must be satisfied by passing the

X. C. MEDICAL SOCIETY. 591

smallest bougie, if any at all, and are justified in calling it an
organic stricture.

Case 4- — J^^ly 19, 1905. Male; age, 55. History: Can
not hear conversation well, ears uncomfortable, and feel full ;
noise in the ears especially when he takes cold ; inspection,
dinun has lost its pink hue and is retracted and somewhat
thickened ; a catarrhal condition is easily made out over the
handle of the malleus and Schrapnell's membrane, l^ose and
nasopharynx free from any obstruction, but in a chronic ca-
tarrhal state of rather a relaxed type, with considerable secre-
tions; hearing of watch, B. S., three and one-half inches;
Rinne test about a draw — neither plus nor minus. By cathe-
terization found the tube obstructed; air would pass into the
tympanic cavity with a shriek, drum would bulge; cocaine
and adrenalin would not reestablish ventilation; therefore,
not congestive, but either a hypertrophic obstruction or an
organic stricture. While anesthetized I passed a small bougie,
which met with a resistance like pushing through something;
the next size passed equally as easy, the air escaped and drum
assumed a neutral position. The hearing worse while drum
was bulging, and better after passing bougie is proof that the
trouble is in the middle ear and not in the internal ear ; and
if this is a chronic catarrhal otitis, the improvement of the
hearing will be in a reverse ratio to the hypertrophic connec-
tive tissue of the mucous membrane of the middle ear, espe-
cially the muco-periosteum covering the ossicles, for this
hypertrophic tissue will become cicatricial tissue, and by Its
contraction will lessen the movement of the ossicles.

Treatment.
The treatment was the reducing of the catarrhal condition
of the nasopharynx by the application of five or ten grains
to the ounce of nitrate of silver; the passing of the bougies
was repeated daily as described for six weeks, when the
largest bougie would pass easily and the tube remained open
and ventilated perfectly. The hearing in case four improved
gradually, and at the end of six weeks could hear watch B. S.

592 FIFTY-FIFTH ANNUAL SESSION

fifteen inches; two months later could hear watch twentv-
foiir inches. Can there be any possible doubt that this was
a case of aerostatic deafness ? With chronic catarrhal otitis
only a limited amount of the connective tissue of the muco-
periosteum has become hypertrophic, therefore, treatment was
crowned by a happy result.

December 14, 1907, ears examined; watch B. S. eighteen
inches. Tubes not ventilating perfectly, I advised a week
or ten days' treatment, which would again put the tubes in a
normal condition. These cases should be examined yearly,
for they have a tendency to relapse.

Continued aerostatic deafness is in those cases where the
hearing is so much impaired that the victim is at a social and
financial loss. It is the exponent of the third stage of
chronic catarrhal otitis; the hypertrophic tissue, by its cica-
tricial contraction, produces an organic stricture of the tube
and stiffens the joint of the ossicles. The aerostatic vascular
and nutritial disturbances will be permanent, the pathological
condition progresses slowly, but surely, destroying the phy-
siological function of the middle ear, as seen in the right ear
of the fifth and last case of this paper.

Case 5.— July 23, 1906. Male; age, 30. Eight ear; se-
vere tinitis for two years. Watch in contact, Einne test,
negative. Left ear, watch twelve inches, Ehinne test, positive.
l^ose, B. S. Intumescent rhinitis septum deviated to right
with ridge ; with this a chronic nasopharyngitis. The noises
make him nervous, and often can not go to sleep for it; at
times so annoying that he must leave his ofiice work and get
out for a while to relax. Is willing to be deaf in one ear, but
must have the noise stopped. Diagnosis: Eight ear organic
stricture of tube, which required but one week to pass smallest
bougie, by gradually dilating its proximal end; the stricture
was about one-fourth of an inch in length. Left ear stric-
ture of tube about one mm. in length, which permitted par-
tial ventilation through a very small opening. Siegel's oto-
scope showed no appreciable movement of the ossicle in right

^'. C. MEDICAL SOCIETY. 593

ear; fair amount in left. The siunming np of right ear, an
organic stricture of the tube with continued aerostatic deafness
or a pathological sclerotic otitis. Left ear diagnosed remittent
deafness, which has been described.

Tkeatment,
Reduced B. S., the intumescent rhinitis, with cautery; re-
moved septal ridge in right nares, established nasal breathing,
reduced congestion of nasopharynx wath solution of silver,
the daily passing of bougies in both tubes, and the appli-
cation of 1 per cent solution ichthyol in alboline to the tube
and middle ear was the treatment pursued. In tw^o weeks
tinitis in right ear beginning to diminish; in six weeks im-
provement so great that he did not notice it except at night or
where everything was quiet. This improvement was in a
direct ratio to the dilation of the tube, establishing ventila-
tion. Hearing in both ears after nine w'eeks ; watch in right
ear one inch, in left ear fifteen inches; tubes ventilating.
May 5, 1907, tubes open right ear, watch two inches; a little
tinitis at times; left ear, watch thirty-six inches, which is
positive proof of continued deafness in right ear, chronic
catarrhal otitis in left, with little damage to the mucous mem-
brane of the middle ear, or else the remarkable improvement
in hearing would not have been after treatment was finished ;
its only therapeutic agent was the ventilation of the tympanic
cavity, with moist, warm air.

594 FIFTY-FIFTH ANNUAL SESSION

THE IMPORTAIsrCE OF THE EAELY DIAGNOSIS
AND TKEATMENT OF THE MASTOID COMPLI-
CATION OF MIDDLE EAE DISEASE.

BY J. M. LILLY, M.n., FAYETTTEVILLE, N. C.

It is not mj purpose, in this brief discussion of my subject,
to go into the etiology, symptoms and treatment of mastoid-
itis, but simply to call attention to the importance of its
early recognition and urge that early treatment be instituted
in every case.

At any time during the course of an otitis media an acute
inflammation of the bony structures of the mastoid may re-
sult. Certain epidemics of the exanthematous diseases and
of lagrippe have been marked by a large number of cases of
this complication. We can not overestimate the gravity of
the extension of an acute suppurative inflammation of the
middle ear to the mastoid antrum and adjoining cellular bony
structures. This vp^ith certain other diseased conditions has
its origin in suppurative inflammation within the tympanic
cavity and is admitted to be the most grave of all diseased
conditions of the temporal bone. It is said that the pioneer
of modern otology, Dr. Adam Politzer, at the first of his
annual lectures on otology, holds a temporal bone in full view
of his class and slowly and earnestly tells them: The tem-
poral bone has four sides — the outside is bounded by life,
from which there comes through the opening of the external
auditory canal one form of our appreciation of what life
means. On the other three sides this bone is bounded by
death.

When we recall the relationship of this bone to important
intra-cranial structures, we plainly see how suppuration here
may cause meningitis, extra-dural abscess, or cerebral abscess,
thus jeopardizing life, besides rendering it a miserable exist-
ence even should these grave complications not occur. The
observation of a few cases like the two I shall briefly report
will make us careful to look for. on the alert to avoid this

N. C. MEDICAL SOCIETY. 595

dreaded condition, and heroic in our efforts to relieve it
should it occur.

Case 1. — A woman fifty-three years of age admitted to the
charity ward on February Tth, suffering very much, and after
the operation she stated that she had no recollection of having
been brought to the hospital. Profuse discharge of very foul
pus came from the left ear. She had suffered from an acute
attack six months before with no surgical treatment, and the
discharge and pain had never ceased. There was redness,
swelling and tenderness over the mastoid. On February 11th
I operated, and as soon as the soft parts were divided down
to the bone there was a gush of creamy pus from a large sinus
in the bone communicating with the mastoid antrum. The
diseased bone was carefully removed, exposing the lateral
sinus, and a complete radical operation was done, including
the removal of the malleus and incus. The wound was
packed with iodoform gauze and dressed daily. The patient
left the hospital March 12, well except there was a small area
over which the skin had not grown. I saw her at my office
a few times, and when last seen the wound was entirely well,
no discharge, and hearing fairly good on that side, but of
course not so good as the other ear. At this time solutions
thrown into the external canal pass into the throat through
the eustachian tube. Had this operation been done months
before untold suffering and danger would have been avoided.

Case 2. — This case will show that not all neglected cases
of mastoiditis are so fortunate as the first case reported.
This case is also a female forty years of age, admitted to the
hospital March 6th with the following history : Early in Jan-
uary she was taken with a severe pain in her right ear and
right side of her head. After a few days of excruciating
pain a foul discharge appeared from the external canal, and
the mastoid became swollen red and tender. The patient
gave some history of tuberculosis in the family and had for
several years been troubled with a cough with considerable
expectoration. She was pale and anaemic and had a con-
siderable rise of temperature. She complained of a severe

596 FIFTY-FIFTH ANNUAL SESSION

and constant headache on the diseased side and occasionally
had spells of vertigo, this being more noticeable just aftei
irrigation of the ear. She was carefully prepared for the
operation, which was done on March 11th. A free division
of the soft parts was followed by a gush of pus, which came
in distinct pulsations, showing a communication with the
meninges. There was a large opening in the necrosed mas-
toid, which was enlarged and the dead bone carefully removed
until the middle ear was exposed. In the posterior wall of
the cavity was an opening partly filled with granulations
which I thought led directly to the lateral sinus, but at the
suggestion of the assistant the soft parts were pulled further
back, bringing into view a larger opening in the bone, through
which a finger could be introduced into the cerebellar fossa
and the pulsations of the brain felt. During the operation
about one-fourth of an ounce of pus was evacuated from the
cranial cavity beneath the dvira. The facial nerve was ex-
posed in a mass of diseased bone, but was not cut. The semi-
circular canals were not exposed. The cavity was flush3d
with normal salt solution and packed with iodoform gauze.
The patient was very weak and we feared would not rally
from the effect of the operation and anesthetic, but she did,
and within a few hours was conscious and talking, there being
no facial paralysis. By next morning, however, there was
almost complete facial paralysis on that side, which had im-
proved some when she left the hospital eight weeks later.
Her wound was dressed daily, all bad odor soon disappeared,
and it was almost closed when last seen ; but the patient still
suffers from vertigo, still has a marked facial paralysis, and
a small opening from the wound communicates with the exter-
nal canal.

While I do not contend, nor do I believe that every case of
acute mastoiditis demands a radical operation, I do believe
that a large majority of them do, and each case should have
careful consideration, and unless rapid recovery takes place
the operation should be done and avoid the serious complion-
tions and dangers attending the delay.

X. C. MEDICAL SOCIETY. 597

AX INTERESTING CASE OF GANGRENE.

BY K. P. B. BONNER, M.D , MOHEHEAD CITY, N. C.

In bringing this case to notice, I shall depart from the
usual custom — that of reporting cases that are successful in
every sense of the word. In other words, this case did not
make a recovery, although the results obtained in the treat-
ment were all that could be asked for, as far as it went. This
is, I think, one fault or weakness of all organizations of medi-
cal men — they try to put the "best foot" forward, so to speak.
However, I am sure that you will find this an interesting case.

The case in question was that of: J. G. ; widow; female;
negi'o; age, 55. Occupation, fanner and clamer. Had always
been a hard worker and had performed hard laborious work
for the greater part of her life. Previous history, so far as
I could ascetain, was good. Family history was unobtainable.

Was called to this patient on the morning of September
28, 1907. On reaching her home, I found that she had l>een
suifering with shortness of breath for about ten days. This
had been gradually growing worse, in the meantime, until
now she was unable to lie down at all. She was propped up
in bed and had great difficulty in breathing, could hardly
talk, as it seemed to tax her respiratory organs too much.
Her sleep was badly interfered with, and appetite was very
poor, in fact, completely gone. The thermometer revealed
no fever. Tongue was heavily coated with a slimy, white
coat. Bowels very sluggish. An examination of the heart
and blood vessels revealed a pronounced valvular lesion, en-
larged heart, and a very irregular pulse. It was evident that
compensation had failed. A slight cough was present, but a
careful examination of the lungs failed to elicit any disease
present in these organs. Kidneys were acting well, so she
said. At this point, I would like to state that, although I
asked repeatedly for a specimen of urine for examination, I
was unsuccessful in ever obtaining it. On one occasion they

598 FIFTY-FIFTH ANNUAL SESSION

sent me about a half ounce in an unclean bottle. ISTothir.g
could be learned from this. The lower extremities were
swollen and oedematous.

I left a purge to open and cleanse the bowels, and also gave
a mixture consisting of buchu, juniper and potassium acetate
in sufficient quantity to make the kidneys act freely and
thereby get rid of some of the oedema in the legs. Tincture
of digitalis was to be administered in ten-fifteen drops doses
every four-six hours to strengthen the heart.

Instructions were given to keep me notified of her progress.
In about two days her daughter came to my office and told me
that her mother was much better. Bowels were acting good,
appetite much improved, and shortness of breath very much
better. However, that since my visit, the patient had been
troubled a great deal with severe pains in her right foot and
leg. Morphine was sent to relieve this. These pains con-
tinued to grow worse until they became almost unbearable,
and after about a week disappeared.

On the 8th of October I was again called, and this time
found that the whole right foot was gangrenous — of the moist
variety. Her foot was of a dark, nearly black color; was
greatly softened, and no matter how deep a needle was thrust
in the flesh did not cause the slightest pain or any feeling at
all. Large "blebs" or bullse had formed on this foot and leg,
some of which had ruptured and were running a watery fluid
of a peculiar fresh odor. A number of small bullae had
formed on the left leg and foot. Her heart was beating
somewhat fast, but was in a much better condition and showed
great improvement at this time. Temperature was beginning
to become elevated, showing beginning of sepsis. She was in-
structed to keep the leg well wrapped, at the same time to use
some disinfectant and deodorant powder. I urged the pa-
tient to immediately get ready to come to Morehead City
(she lived six miles in the country), so that the foot could
be attended to daily and amputated at the proper time.

In spite of this advice, nothing more was heard from the
patient until six days later (October 14th), when I was

]!^. C. MEDICAL SOCIETY. 599

again called. When about fifty yards from the house a
bad odor was noticed; and upon going into the room and
examining the affected foot and leg, the cause of the bad odor
was explained. The gangrene had extended on up the leg
to a point some three inches below the knee joint. At this
point there was a sharp line of demarcation which extended
in an irregular line around the leg. The moist gangrene had
now become converted into a moist putrefactive gangrene and
the soft parts were just a pulpaceous mass. The gangre-
nous area was of a greenish black color. The odor was truly
horrible, and I must confess nauseated me. The swelling
and bullae in the left leg were beginning to disappear and the
chances looked Bright for no serious trouble with this limb.
The patient had developed a high temperature and had had
one or two chills. It was evident that septic poisoning was
already at work. ]^o time was to be lost, and I plainly told
them that the leg had to come off or she would die. By this
time the patient herself realized that the leg was dead; she
must lose it. She agreed to come to Morehead City and to
try to come that day.

After returning to town, I looked for her all day, but she
did not come. Finally, on the afternoon of the next day
(October 15th) she came. Her temperature was mounting
higher and higher. Chances looked very slender for her re-
covery. Septic poisoning had set in in dead earnest, with
all the symptoms attendant. The senses were very much
dulled and thinking capacity and memory were nearly gone.

Preparations were immediately begun to amputate, and
on the next morning (October 16th) the chances appeared
so small that it looked to be a hopeless task. The pulse was
180 and so weak that it was hardly perceptible. Her gen-
eral condition was correspondingly bad. As this was her
only chance we began the amputation. My colleague. Dr.
W. E. Headen, administered the anesthetic which was
chloroform, ether was not obtainable. The patient took the
anesthetic badly. A hypodermic of strychnine and atropine
was administered before we began. After an examination

600 riFTV-FIFTII ANXUAL SESSIO:V

of the leg it was decided that an amimtation at the knee joint
was the best procedure. The gangrenous leg was wrapped
in towels wrung out in hot mercury bichloride solution. Tlie
tourniquet was applied and the field of operation was steril-
ized as well as possible. The amputation was made by a
long anterior and short posterior flap method. In making
the. posterior flap, after cutting the anterior flap and unjoint-
ing the knee joint, just as I cut through the skin from within
out and the leg was severed, there was a gush of pulpaceous
fluid which came from a sinus that led up the posterior aspect
of the knee joint for about three or four inches under appa-
rently healthy skin. There was nothing to do but go higher
up with the amputation. The popliteal artery was tightly
plugged with a well-organized thrombus. I cleansed my in-
struments as well as possible and amputated five inches above
the knee joint. This was well within the healthy area of
tissue. The same kind of flaps were made and were sewed
up and drainage left in. The stump was dressed in the usual
manner.

At this point I will remark that the patient practically died
twice on the table ; each time respiration and heart ceased.
The last time a hypodermic of 95 per cent alcohol (20
drops) was administered, which soon revived her. The total
time consumed in the two amputations, however, was not
much over an hour.

I remained with the patient nearly all day, and about 4
o'clock in the afternoon she began to revive. By night she
was much better. Her mind was much clearer and pulse
had dropped to 120 and was stronger. The next morning and
afternoon (Oct. 17th) improvement continued steadily. In
the afternoon of this same day her pulse and temperature
reached normal. Appetite was good. Chances now looked
bright for a speedy recovery.

On the morning of the ISth we dressed the stump and
healing was progressing nicely. There was some little sore-
ness in it. Improvement of her general condition was steady
and uninterrupted. Pulse and temperature normal. Senses

N. C. MEDICAL SOCIETY. 601

clear and appetite much better. Bowels and kidneys were
acting much better ; in fact, well.

On the morning of the 19th temperature was 101^, but the
pulse showed no change from normal. Patient was perspir-
ing freely. In the afternoon temperature was normal but the
pulse was 100-110. Something was evidently wrong and
seriously wrong at that. On the morning of the 20th tem-
perature was 102.5 and pulse normal. The afternoon of this
day showed a pulse of 120 and temperature of 102.5.

When the peculiar ranges and wide variations between
the temperature and pulse began I would examine the stump
and left foot and leg carefully at each visit. The stump re-
vealed no cause for the trouble as it kept on healing. It was
draining nicely and the exudate was ordinary wound fluid
with no odor. The left leg and foot seemed to be improving
steadily. The swelling was subsiding and was nearly all
g.re. The bullae had disappeared except one large one on
the dorsum of the foot. This was shrinking and nearly
gone. The foot, nevertheless, was cold and the patient com-
plained of it being numb. Hot water bottles were kept to
it constantly. The next morning (Oct. 21st) the left leg re-
vealed the cause of all this disturbance. The lower part of
the calf was gangrenous. The area was probably the size of
a silver dollar or larger. Immediate amputation at a level
with the other stump was advised. The operation was re-
fused as the patient said "she preferred death to the loss
of both legs."

There was nothing to be done now but make the patient
just as comfortable as possible until death relieved her suf-
fering. I continued my visits until she died on the morn-
ing of the 23d. The gangrene soon involved the whole foot
and then spread progi'essively up imtil just below the knee
joint. The line of demarcation was beginning to form just
before she died. The same horrible odor was present as in
the former limb, because this, too. was the moist putrefactive
variety.

602 FIFTY-FIFTH ANNUAL, SESSION

There are two valuable lessons to be derived from this
case. First, that it is never too late to amputate in gangrene.
I can fullj agree with the late Dr. ISTicholas Senn, who cites
cases in which the patient was no near dead with septic pois-
oning that no anesthesia was necessary. The amputation
would be made, and, even with these worse than desperate
chances, would make a rapid and complete recovery, showing
the wisdom of operative interference at any stage of the dis-
ease. Second, that great care should be exercised that am-
putation is well within the area of healthy tissue. It is bet-
ter that some of the healthy tissue should be sacrificed than
that the operation be too low and make a second one neces-
sary, and this with contaminated instruments and the danger-
ous possibilities for the patient, prolonging the operation,
as well as greatly ruffled temper.

In my opinion the cause of this trouble was endocarditis.
This inflammatory condition produced vegetations or granu-
lations on the aortic valves, and the force of the circulation
broke off a piece of these vegetations which passed directly
down until reaching the bifurcation of the popliteal artery,
and here lodged on account of the diminished calibre of its
branches. This embolus was rapidly converted into a throm-
bus. The extent of the gangrenous area bears me out in
this opinion, or at least shows that the source of the trouble
was in or near the knee joint, for the line of demarcation
appeared just below the knee joint in each instance. An-
other reason for holding this opinion, theory if you will call
it, is that there was certainly valvular disease present. Fi-
nally, there was absolutely no history to point to an external
agency as a cause.

I shall always feel that this woman's life could have been
spared had she consented to an amputation of the last leg.
The results with the first justify me in this belief. This,
however, is nothing more than mere conjecture and so is use-
less talk. I shall amply be repaid if this furnishes you any
''food for reflection" as a result of the report of this unusual
case.

N. C. MEDICAL SOCIETY. 603

AN Ks^TEEESTING CASE OF STONE IN THE
BLADDER.

BY J. M. PAEBOTT, M.D., KINSTON, N. C.

On February 21, 1906, by invitation, before the Onslow
County Medical Society, I read a paper with the title "Supra-
pubic Cystotomy — A Study." In this paper I reported a
case which had been in my care. From this paper I quote
extensively. My excuse for discussing it again is because of
the developments which have arisen since it was first reported.
In the spring of 1897 I was consulted by Dr. S., age fifty-
eight. Fifteen years prior to that time he began to suffer
from a traumatic stricture of the deep urethra. When first
seen he was much emaciated and presented the usual symp-
toms of urethral stricture of the most aggravated type.
■^ * * After careful treatment by dilatation the stric-
ture was somewhat relieved. The vesical symptoms of which
he complained a great deal continued and I diagnosed cys-
titis. My notes of that time say "When seen he presented
well-marked symptoms of vesicle calculus, though the stric-
ture was too tight to permit a confirmation with bougie or
stone searcher." Altogether he was a very bad subject for
operation. He was a physician. He held to the stone in the
bladder diagnosis and insisted on an operative procedure.

I elected to do a perineal section because of the existing
urethral stricture. After entering the bladder two large
stones were found. Because of certain circumstances then
existing I could not remove the stone via perineam, and at
once did a suprapubic cystotomy. The two stones first
found were removed and a third one discovered imbedded
in the posterior bladder wall. A drainage tube was intro-
duced into the suprapubic wound, and on the sixth day after
the operation a violent hemorrhage began which continued
more or less freely and intermittently for two days, being
finally checked by through and through irrigation with very

004 FIFTY-FIFTH ANNUAL SESSION

hot water. With this excej)tion he made an uneventful re-
covery.

In March, 1902, I again removed a stone suprapubicallv.
This time he made an uninteresting and rapid recovery.
On January 30, 1906, I did a third suprapubic section and
removed another stone. On the fifth day after this operation
he was sitting up and on the seventh out visiting. In my
paper to which I have before referred I predicted the forma-
tion of another stone within a year or two from that time
(February 27, 1906) ; my prognosis has come true. On
March 31, 1908, I again did a suprapubic cystotomy and re-
moved a stone weighing about 600 grains ; he soon recovered
and was enabled to walk on the streets. Two weeks after
the operation the wound had entirely healed. The last two
operations were done with local anesthesia, except the ad-
ministration of a few drops of chloroform at the close of the
seance to facilitate the delivery of the stone by relaxing the
recti abdominalis.

Quoting from my paper of February 21, 1906:

"This to me has been a most interesting case and is worthy
of close study. It presents for consideration six points of in-
terest :

First, he is and always has been a man of good habits. His
personal history is negative, especially as to renal colic or
any manifestation of litha3mia. While he has always lived
an active outdoor life, yet his exposure has been nil. His
figure is spare, and aside from this vesical trouble and trau-
matisms his health has always been good.

"Secondly, the indications calling for the operations were
three in number: Stricture, which demanded a perineal sec-
tion ; a very violent and infective cystitis, due in a large
measure to dirty bougies, and the stones. The perineal sec-
tion was done at first because of the stricture. It has never
been a popular operation with me and I had a splendid op-
portunity in this case to study the two together.

"This leads me to consider the third point of interest, viz :
That suprapubic cystotomy in the majority of instances is

N. C. MEDICAL SOCIETY. 605

decidedly preferable to perineal section. When a case pre-
sents itself in which the bladder should be opened the first
question which naturally presents itself is which operation
is indicated ? The answer must be made in accordance with
the conditions presented in a given case. Suprapubic cys-
totomy is unquestionably the preferable operation for for-
eign bodies, tumors and chronic cystitis, but is it better all
things considered than the low operation for stone in the
bladder ? I believe it is. * * * j believe a compila-
tion of statistics covering the last ten years would be de-
cidedly favorable to suprapubic cystotomy. There are un-
foreseen conditions which may arise during and after the ope-
ration which give the high method a great advantage. When
hemorrhage occurs after the operation, as it did on the sixth
day in the case report'jd., it can be easier controlled than it
could be possibly should it occur after perineal section.

''It is true that often one can form approximately a cor-
rect idea of the size of the prostate b}' rectal palpation, etc.
Still in concentric prostatic hypertrophy this preoperative
idea is crude. Hence in these cases the advantage is decid-
edly in favor of the suprapubic method. Should the stone
prove a large one (and who can measure its size before going
into the bladder) as in the case under study, the surgeon
then in that event would be forced to go above the pubes or
else crush the stone, and thus add a litholopaxy to the perineal
section. * * * By perineal section it is possible to over-
look an imbedded stone even after careful digital explora-
tion. This occurred in my case, but fortunately I discovered
it after opening the bladder above. * * *

"'Bryant says 'the method (suprapubic) pennits of a com-
plete inspection of the bladder, obviates all danger of injury
to the structure of the neck of the organ, and establishes a
wound in a favorable site for cleanliness.' He further says:
'Irrespective of the foregoing (statistics quoted by him) re-
sults it should not be overlooked that one is likely to succeed
best, other things being equal, in the use of the method of

606 FIFTY-FIFTH ANNUAL SESSION

practice with which he is most familiar.' In the case under
consideration it succeeded after perineal section failed; it
met every indication. * * * Xhe violent cystitis which
unquestionably developed independent of the stone and from
outside infection could have been managed better by the
higher operation. The hemorrhage to which reference has
been made could not have been controlled by and through the
perineal section as by and through the high opening."

"The fourth point of interest is the operative method pur-
sued. The perineal section was the classical lateral operation
and needs no comment. The suprapubic section was strictly
according to the rules. * * * "With the first operation
on the patient under discussion I used the rectal bag and
dilated the bladder with eight or ten ounces of boric solu-
tion. * * * After the first and in the second and subse-
quent operations I simply dilated the bladder and did not
inflate the rectum.

"Strange to say I found but few adhesions in the space of
Ketzius at the second operation, but the bladder was found
united to the abdominal wall at the third seance. So that,
while the second was a typical suprapubic cystotomy, the
third was not more difficult than opening an abscess."

The fourth suprapublic cystotomy, as were the second and
third, was through the original scar, and while it was not so
simple as the third, was not as difficult as the first or even the
second. At the time of the fourth operation, a few weeks
ago, the patient was sixty-nine years old.

Again quoting from the paper presented to the Onslow
County Medical Society :

"The fifth and most interesting complication in this case
was and is the recurrence of the stones. Did the urethral
stricture contribute to the stone formation in the original
instance, and has its contributory influence been felt in the
production of subsequent stones ? Decidedly yes. Given a
possible constitutional tendency to stone formation (which is
not apparent in this case) and an urethral stricture will prove

N. C. MEDICAL SOCIETY. 607

a powerful etiological factor. The stricture may produce an
actual dilatation of the entire bladder wall or some section
of the same. In this way it may add largely to the amount
of the residual urine. The bladder of this patient presents
a strikingly large pouche or cul-de-sac in its lower and pos-
terior wall. In this a large quantity of urine remains at all
times since it can not be entirely emptied, and here the stones
constantly reform. The bladder was explored by the finger
and carefully irrigated many times after each operation, and
the writer is very positive that no stone remained.

"The last complication to which I desire to call your at-
tention was the hemorrhage on the sixth and seventh days
after the first operation. A stone deeply imbedded in the
posterior w^all was removed at the first operation, and neces-
sarily a raw surface remained. I left the drainage tube in
for some time, and it was in situ when hemorrhage occurred.
It is my present opinion that the tube by friction produced
an ulceration of the mucous membrane, perhaps, and more
than likely at the site from which the imbedded stone was
removed. There is really no necessity for leaving a tube in
the bladder longer than forty-eight hours, unless there is an
infective cystitis, and then in that case an olive-pointed tube
or Senn's syphonage tube should be used."

I have used, usually prescribed and generally recognized,
constitutional treatment together with vesical irrigations as
prophylactics in this case with no appreciable result. I pre-
dict the formation of another stone in eighteen months or two
years. His stricture has caused no special inconvenience
since the first operation. He has kept this well dilated and
has used reasonable care with success to prevent infective
cystitis. Would it be better to try to remove the vesical cul-
de-sac by surgical procedure if it could be done, which 1
doubt, and thus rid him of a probable causative factor, or run
the no doubt increased risk of another stone if the pouche be
an etiological element. I am of the opinion that the latter
is decidedly the better course to pursue.

60S FIFTY-riFTH AIN^NUAL SESSION

IIs^FLUE:NrZAL AETHEITIS.

BY JAMES J. PHILIPS, M.D., TARBOEO, N. C.

I desire to present, in as few words as seem practical, the
histories of two cases of well-defined grippe in which the pri-
mary and cardinal symptoms were exhibited by the joints.

Some hesitation has arisen in my mind in regard to the
proper expression which shonld designate this interesting
form of lagrippe. The term rheumatoid grip is possibly open
to criticism since to many minds it connotes the idea of some
preexisting constitutional dyscrasia, while influenzal arthritis
conveys the idea of involvement of the articular surfaces, a
pathological condition not observed. Either heading, at all
events, will serve my purpose when it signifies a condition
arising in the course of lagrippe wherein the joints share in
such a pronounced degree as to modify the clinical picture
and to constitute the particular feature of the seizure.

It was my experience during the past winter, in the man-
agement of some obstinate cases of lagrippe, to encounter two
cases which exhibited inflaiumation around the joints of such
nature and character as to render interpretation difficult.
Each case began as lagrippe, with symptoms generally ac-
cepted, and continuing as such developed, with more or less
promptness, articular pain and tenderness, swelling of the
peri-articular tissues, a moderate amount of effusion into the
joints and impairment of function ; in a word, an exudative
inflow motion of a moderate grade in and around the joint
cavities. Case two exhibited these features in the right ankle
and right knee, the inflammation beginning simultaneously
in both joints. Case one, subsequent to involvement of both
knees, both ankles and both big toe joints, and, before resolu-
tion, both wrists and the left shoulder became similarly af-
fected. With each onset were associated an exacerbation
of fever and a degree of discomfort distressing. So distinct
and sharply-featured were the seizures that in onset and

K. C. MEDICAL SOCIETY. 609

course, in duration and decline, the condition paralleled
acute rheumatism very closely. It would be a mistake, how-
ever, to regard these cases as rheumatic unless the term be
employed in a generic way and made to comprise several
\-arieties of infection. In neither case did the anamnesis
supply a history of previous rheumatic attacks, articular or
muscular, in patients or correlation, nor did there exist, so
far as could be clinically observed, an involvement of the ar-
ticular surfaces. There was no sweating. Though the cases
featured rheumatism they were not true rheumatism. So,
then, for the purpose of a correct and prompt interpretation,
since these cases readily lead to error, it would seem justly
desirable to separate them, and as a matter of expediency to
specify such ''influenzal arthritis." In the light of such a
designation your attention is called to cases w^hicli exhibited
the following histories and symptoms:

Case One. — On March 8, 1908, J. S., age forty-four, is
in bed with fever 102 degrees F. ; pulse 120. He has been
ill for three days with aching in back and limbs, a cough and
fever, and has taken to bed by reason of an increase in se-
verity of these symptoms. He had an attack of lagrippe sev-
eral weeks previously, though indifferent therapy had not
fully restored him before he is dovm again. There is no
joint involvement. The symptoms are purely subjective
though there is noticed some pain on active motion of the
lower limbs. He has never had rheumatism. On March 9,
1908, three days later, six days from onset, both feet, both
ankles and big toes, both knees develop pain. The onset is
rather abrupt. The joints become diffusely swollen, puffy
and very tender to pressure. The digits particularly are
tense, swollen and shiny in consequence of a serous exuda-
tion. There is spontaneous pain and pain on motion, while
the local symptoms are offset by a rise in temperature of one
and one-half degrees and a relative increase in pulse rate.
The external appearances recall rheumatism. It is obvious,

610 FIFTY-FIFTH ANNUAL SESSION

however, that most of the swelling is in the tissues around the
joints, though some effusion into the cavities is undoubtedly
present. Such was the condition on March 9, 1908. On
April 2, 1908, the patient is up and about. He presents the
appearance of having had a severe illness. There is corre-
sponding emaciation and weakness. The joints, however,
are free from pain, the swelling has subsided, the function
restored and, apart from some atrophy above and below the
joints (best observed in the knees), there is slight if any
trace of the former involvement.

The physicial condition presented in this interim was that
of an acute inflammatory state of the joints. It was punctu-
ated on March 18, 1908, by a milder yet just as character-
istic involvement of the wrists and the left shoulder. Here
again was a rise in fever and pulse rate and increased dis-
comfort. The process was similar to the original one and
evidently arose from the same cause, representing an exac-
erbation. The joints presented the same characteristics.

The subsidence of the process was in accord with the usual
history of similar conditions yielding to therapy and occu-
pied about twenty-three days.

Case Two. — An adult male, a laboring man, age twenty-
seven, the victim of lagrippe ; ill for several days with fever,
headache, general aching, a dry, hacking cough and prostra-
tion. There is nothing unusual in the history nor in the
progress of the disease to date. He has never had rheuma-
tism nor gonorrhoea. Temperament, nervous.

February 12 and 13, 1908, represent the fifth and sixth
days of illness, which are passed in moderate comfort. The
fever has ranged from 103 degrees F. to 101 degrees F. ; the
pulse from 128 to 110. He presents the symptoms of la-
grippe. Insomnia from the beginning of the illness, and
throughout has been troublesome. On February 14, 1908,
there comes on a diffused swelling and redness of the right
ankle and the right knee. Associated is a rise in fever to
103 degrees F. and a pulse rate of 122. The joints are red.

N. C. MEDICAL SOCIETY. 611

hot and (XEdematoiis, the seat of an acute process. The swell-
ino; is not so much from effusion into the cavities as from
oedema of the surrounding tissues, and is confined to the im-
mediate neighborhood of the joints. Tension is not great;
there is no local nor general sweating. The joints are very
painful, hypersesthetic to slight touch and most comfortable
in the characteristic position of semiflexion (knee). At rest
the pain is of a dull nature, upon motion acute, and consti-
tutes the overshadowing local symptom. This condition of
affairs remained practically unabated for fifteen days, during
which the patient suffered greatly. Of the elements in the
condition the swelling was never very great, the amount of
fluid in the joint not abnormal, though tenderness to touch
and on motion was exquisite. The redness and heat increased
rapidly at first, and at one point it looked as though the joint
would suppurate. There was scarcely a semblance of func-
tion. The period of beginning decline, February 29th, was
coincident with improvement in the general symptoms. It
was first noticed when the heat and redness began to gradu-
ally disappear. Abatement of pain permitted on March 11th,
the 26th day, a fair range of motion, while on March 15th
the patient was able to present an extended limb with to and
fro motion at the joints. The swelling persisted, however, at
this date. The right knee measured 3 cm. and the right ankle
2 cm. more than the corresponding joints of the sound limb.
This symptom was the last to subside. Though gradually
abating some puffiness of the ankle w^as observed for three
weeks more though the patient was up and about on March
22, 1908. The process lasted acutely from February 14 to
March 15, 1908; subacutely for seven days more when the
joints became apparently normal save puffiness of the ankle,
observed for an additional nineteen days.

In these as in similar instances in which symptoms refer-
able to the joints predominate, the clinical picture of lagrippe
is obscured almost if not quite beyond recognition. The
prime factor underlying them, I regard, a systemic intoxi-

612 FIFTY-FIFTH ANNUAL, SESSION

cation, though it has not been made bacteriologically clear
whether the condition is due to the influenza bacillus itself
or to its toxins or to both, nor clinically clear under just what
conditions the domiciled bacillus may thus develop undis-
turbed. There is not sufiicient reason for believing that la-
grippe has prepared the parts for secondary infection nor
that true rheumatism has developed upon a fertile and pre-
disposed ground. It would seem plausible, and my experi-
ence lends support to the view, that it is a question of inten-
sity of action, an expression of a high degree of toxaemia and
that no new or reinfection is at all required. As much at
least seems fairly scientific when we consider that a specific
action of the toxins of lagrippe not infrequently centers itself
around the joints when joint aches and pains become very
common. These, so long as they comprise a part of the symp-
tom complex remain as symptoms solely, are amenable to
therapy, do not leave the joint with impaired function and
rest upon slight pathological change. They express a stage
of pathological irritation resulting in congestion and nerve
involvement. In allowing intense action upon such an irri-
tated basis my judgment is completely satisfied in explana-
tion of the clinical findings. Congestion and irritation will
thus readily pass into exudation and the irritated joint ex-
press itself pathologically in exudate, in involvement of its
tissues (particularly the serous membranes) and clinically
as in the cases above recorded.

This conception lends itself also to other important con-
siderations. Reference to the records of such cases as are at
my command would lead one to expect the condition to usu-
ally follow lagrippe, constituting a sequel and prolonging the
convalescence. This fact is well illustrated in the history
of a case recorded in the Lancet, July 18, 1903, where four
months was occupied in the process. Such was not the ex-
perience with these cases. Reference to them shows that in
each instance the condition arose during the active seizure
and at the height of the toxaemia, which seems much more logi-

iSr. C. MEDICAL SOCIETY. 613

cal and consistent. Particularly is this true if the toxins be
held responsible for the condition, a view to which I am com-
mitted, tboug-h purely upon clinical grounds, for no bacterio
logical examination could here be made. The true signifi-
cance of the association necessarily resting upon this can not,
therefore, be thoroughly appreciated or satisfactorily estab-
lished, and the question as to whether the clinical picture is
an exj)ression of a toxaemia or a bacterisemia must remain
unsatisfactorily answered.

It would appear that few observations have been made of
the occurrence of arthritis in lagrippe. Having regard to
their comparative rarity, these cases furnish sufficient inter-
est to warrant reporting, though the material is not at hand
to form the basis of a complete picture. It has been my pur-
pose to present them in a practical rather than in a doctrinal
manner. They are of value in showing that an acute process
may arise in lagrippe which runs a course very much as does
acute rheumatism, yet with the promising feature of an ulti-
mate good result. They represent a complication, serious in
that it accentuates an already serious state, while at the same
time exposing the joints to still more extensive involvement.
They express a high degree of bacterial or toxic activity.
How far, under proper conditions, this may proceed rests
upon future observations. In so far as these two cases would
lead us to believe, under judicious care, we may expect a
good prognosis, though the course is apt to be severe.

614 FIFTY-FIFTH ANNUAL SESSION

EMPYEMA: ETIOLOGY, SYMPTOMS, TEEATMENT
AND WHEInT to do THORACOTOMY, WITH RE-
PORT OF CASES.

BY JOHN T. BUEEUS, M.D., HIGH POINT, N. C.

Mr. President and Gentlemen of the North Carolina Medi-
cal Society: — In looking over the records of papers and re-
ports of cases before the l^orth Carolina Medical Society, I
am unable to find a report of empysema or any article on the
subject, and since I have had a number of cases I have taken
this for my text. Therefore I invite your attention to this
subject for a short while.

The term empysema denotes the presence of pus in the
pleural cavity (or pleural abscess). We have two classes of
cases, that of empysema in childhood and in adults. In child-
hood it is very plain and the symptoms enable us to make a
very early diagnosis.

In adults the diagnosis is very much more difficult to
make, and usually requires a longer time than it does in child-
hood.

Etiology. — The causes of empysema are due to the presence
of biogenic bacteria in the pleural cavity, and is almost al-
ways secondary to some other disease.

1. Secondary to sero-fibrinous effusions, where thoraceute-
sis has been performed for sero-fibrinous effusions and anti-
septic measures have not been strictly adhered to. Secondary
to pneumonia, scarletina, pysemia, tuberculosis, dysentery,
and sometimes measles, whooping-cough, carious ribs, carious
vertebra and trauma.

2. Lymphatic metastasis is a probable way in which bac-
teria reaches the pleura from neighboring tissues. The or-
ganism which in most every instance has been found to pro-
duce this condition is the micrococcus lancolatus, strepto-
coccus, staphylococcus and tubercle bacillus.

Symptoms. — The history of the patient is important and

N. C. MEDICAL SOCIETY. 615

my experience with the disease shows that 90 per cent of all
cases occur after pneumonia or pleurisy.

Where the case has run an ordinary course of pneumonia
or pleurisy and perhaps the patient begins to improve, fever
reducing, and at the time apparently begins to convalesce.
For a few days the patient has every indication of doing well,
when a chill comes on followed by fever and a pain in side.

The symptoms are at first looked on as a relapse. In a few
days dyspnoea, restlessness and immobility of the affected side.

In childhood the symptoms are more rapid in developing
than in the adult. In a few weeks the clinical picture has
changed. The patient that was once plethoric now becomes
very much emaciated. The loose cough suggesting a tubercu-
lar condition, which is in many cases confirmed when the
night sweats appear. The general appearance of the patient
is that of extreme exhaustion.

Physical signs are pains in the affected side, dyspnoea and
evidence of absorption of pus, skin cold and clammy and
ofttimes bathed in perspiration. Respiration is from 36 to
50 to the minute ; temperature varying from 101 F. to 105 F.
There is a dullness in the affected side with change of sound
according to the position of the patient. A disappearance of
vocal fremitus on the affected side. The respiratory murmur
is nil. The bronchial murmur may be perceptible if the ac-
cumulation is not too extensive, but if the effusion is suffi-
cient to occupy most of the pleural space, then bronchial mur-
mur is not heard.

In childhood the bulging of the affected side is not so
marked as in the adult, owing to the thoracic viscera being
less resistive and more easily displaced. In the adult there is
more bulging of the affected side with obliteration of inter-
costal spaces. In the adult the heart is not so much displaced
as in childhood.

On measuring the side from the center sternum to the
spinus processes the affected side is seen to be larger, varying
according to the amount of pus in the cavity.

616 FIFTY-FIFTH AXNUAL SESSION

In some cases we have rupture into the bronchi of pus.
which is expectorated, and occasionally this relieves the pa-
tient and recovery is the result.

Treatme7\t. — In eases of empyiiemia I have very little faith
in leaches, blisters, poultices or other external appliances,
which have been suggested ; neither do I believe in waiting for
these cases to rupture or to go so long that the bulging is so
extensive that it is ready to rupture externally. But as soon
as a diagnosis can be made I think that every case should be
operated on.

Usually we allay pain, so that our patient may be more
comfortable, and give a mercurial purge, supporting the heart
by giving heart stimulants and diffusible stimulants such
as ammonia, strychnine, atropine and digitalin. But the
only thing that I have done in these cases that have given me
any results is thoracotomy as early as I could make the diag-
nosis. And the positive diagnosis is made by the introduc-
tion of a trocar obtaining pus.

The positive diagnosis made, I next proceed to do thorac-
otomy. This should be done by making an incision two and
one-half inches long in the sixth or seventh interspace in the
mid-axillary line ; first observing the strictest antiseptic meas-
ures.

If the space is large enough to admit a large size rubber
tube then it is sufficient; but if not, you should resect a rib
which is done in the usual way. This gives a space sufficient
to allow a free drainage. The tube should be held in situ
by ligatures. To the drainage tube there should be a long
tube connected, which conveys the fluid from the drain to a
vessel containing an antiseptic solution. This acts for two
purposes :

1. Preventing the induction of air, dust or any infection
into the pleural cavity.

2. Prevents the dressing from becoming soiled by the
drainage, thereby making it more comfortable for the patient.

The after care demands a consideration: (1) Stimulate

N. C. MEDICAL SOCIETY. 617

and nourish; (2) to see that the tube does not become ob-
structed, thereby facilitating the free escape of the fluid.

As long as the flow is free I never irrigate the cavity, but if
the flow is very tenacious and does not flow freely then a
weak solution of permanganate of potash or a normal salt
solution is used to irrigate the cavity.

Strych. nitrate and syr. hypophosphites and nourishment
are always instituted, and the patient urged to take plenty
of fresh air.

Thoeactomies.

Case No. 1. — Mollie J., age eleven years; white, history
good. jSTo scrofula, syphilis or tuberculosis in family. Was
taken ill December 15, 1907, with chill. Fever 105 F., pulse
130, high arterial tension, a rapid respiration and severe pain
in left side, complaining of aching all over body.

I examined the patient on the evening of the same date
and foimd her with pneumonia of left lung.

The case ran a rather severe course to the eighth day when
fever terminated by crisis and patient began to improve.

On the fourteenth day I dismissed the case, as the patient
was now sitting up and very desirous of food, the cough
having almost subsided by this time.

Six days later I was called in and found that three days
after I dismissed the case she had developed a chill, rapid
respiration and a good deal of fever, having a severe cough
and unable to expectorate anything ; dyspncea marked and an
inability to lie off of the affected side-

I found upon examination that there was slight oblitera-
tion of intercostal spaces, and heart was displaced to right
as far as the median line of sternum, with dullness over the
entire left side.

I introduced an exploring needle into the thoracic cavity
and obtained nothing; whereupon I did not advise an opera-
tion.

Four days later I made another exploratory puncture and
obtained a small amount of pus. I advised an immediate

618 PIFTY-FIFTH ANNUAL SESSION.

operation, and on the following day Dr. Duncan and myseli
did a thoracotomy, going through the sixth interspace, between
the mid-axillary line. We introduced a drain and, while at
first the discharge was very slight, owing to the thick, tena-
cious pus, but by the third day the patient was discharging
large quantities from the tube. The tube remained in situ
three weeks and was removed.

The patient is w^ell and in a fine physical condition, suffer-
ing no discomforts from the side, and has made a speedy and
uneventful recovery.

Case No. 2. — L. A. L.'s child, female ; age seven. Family
history good. Father and mother living, two brothers and
one sister ; none dead. Child previous to the attack was very
stout. Had never been sick, except measles at the age of two
years, from which she had recovered.

January 25, 1908, patient was taken ill with pneumonia,
which was treated by another physician. On April 1st Dr.
Dorsett was called and diagnosed empysema and urged an
immediate operation. The family objected to this, and on
the 14th of April I saw her with Dr. Dorsett and obtained the
following history:

On January 25th child was taken ill with pneumonia in
left side and was very sick for two weeks, then she began to
improve, and at the end of the third week sat up in bed and
called for something to eat. At this time she had no eleva-
tion of temperature and was getting better. At the end of
the fourth week patient had a chill and a slight rise of tem-
perature, pain in the side and difficult breathing, and a dry
cough that worried her a great deal, but was unable to ex-
pectorate anything.

The case went on this way until the end of the eighth
week. Child spit up quite a quantity of what the parents said
looked like pus. Then she improved for a week, but from
that time she grew worse up to the time I saw her, April 14th.
Saw case and found extreme emaciation; temperature 101
F., pulse 140, respiration 46 ; skin cold and clammy and

X. C. MEDICAL SOCIETY. 619

bathed with perspiration. A very anxious expression on her
face, and every few minutes she would have a paroxyism of
a very severe cough and was unable to expectorate.

Physical examination revealed the following: Heart dis-
placed two and one-half inches to right of sternum and up-
wards, obliteration of intercostal spaces on left side and
(edematous.

Measurements revealed the following: Left side two
inches larger than right. The abdomen was distended and
the child was nothing but a bony frame covered with integu-
ment.

On April 15th Dr. Dorsett and myself did a thoracotomy,
using very strict antiseptic measures; making an incision
two inches long in the seventh interspace in the mid-axillary
line.

A large rubber tube was introduced and anchored by liga-
tures. We removed five pints of liquid pus. The child's
abdomen reduced and the heart became less irritated and the
pulse less frequent.

We attached to this drainage a long tube which conveyed
the pus to a vessel partly filled with an antiseptic solution.

The tube remained in situ for three weeks and drained
freely all the time. Then we changed the drainage tubes,
using a smaller one, and irrigated with a weak solution of
hydrogen dioxide. The tube remained in situ for three
weeks longer, making six in all. When there was no further
drainage it was removed.

After the operation the child was put on syr. of hydriatic
acid, nutritious diet and the open air.

This case made a good recovery and has gained in flesh a
great deal.

I report the two oases to show the difference where earlier
operation is instituted and where the case has been allowed
to remain so long without surgical intervention.

620 FIFTY-FIFTH ANNUAL SESSION

MANAGEMENT OF THE THIRD STAGE OE LABOE.

BY B. E. GEAHAM, M.D., WALLACE, N. C.

After the cord has been tied and the child delivered to the
nurse we must realize that the most important duty to the
mother is yet to be performed, and upon the conscientious
performance of this duty will largely determine the satisfac-
tory progress of our patient during the puerperium and her
future health and comfort. The improper management of
this stage of labor jeopardizes the woman's immediate safety
and may entail upon her a future life of suffering and in-
validism.

Our first fear is post-partum hemorrhage, and as precau-
tionary against this we immediately grasp the fundus of the
uterus, and if it has not already contracted we encourage this
condition by gently kneading with the open hand. The con-
dition of the uterus is now carefully watched, the hand being
applied to it at frequent intervals, but kneading is resorted
to only when required. In the majority of cases after an in-
terval of fifteen or twenty minutes the placenta has become
spontaneously separated from its uterine attachment and
has been thrown into lower uterine segment or upper vagina
by the contraction of uterus, which is evidenced by that organ
rising up against anterior abdominal wall and at the same
time remaining firm and hard. The placenta is now expelled
by grasping the uterus and making downward pressure in the
axis of the superior strait, using the uterus merely as a piston
to shove the placenta downward and outward. When the
latter appears at the vulva it should be grasped by the right
hand, which has been almost continuously held in bichloride
solution, and gently removed. The membranes which follow
are carefully twisted into a cord so as to prevent their beinp
torn off from the margins of the placenta, after which they
are slowly extracted.

N. C. MEDICAL SOCIETY. 621

We sometimes experience difficulty in expelling the pla-
centa entirely from the vagina in this manner and under these
circumstances I find it expeditious to introduce two or three
fingers into lower vagina and seizing placenta by the margin
make gentle traction to remove it. It frequently happens
that small portions of the membranes may be left behind.
If the ends be outside the vulva they should be seized and
the remnants delivered by gentle traction, otherwise it is in-
advisable to introduce hand into vagina in an attempt to re-
move them. Having removed the placenta we should reexam-
ine the fundus and see tha|; it remains firmly contracted,
which condition is maintained at this stage by the adminis-
tration of a dose of H. ext. ergot.

Having accomplished this we should now turn our atten-
tion to the condition of the perineum, which if patient is a
primipera we will almost surely find lacerated to a more or
less extent. Some authorities recommend that the perineum
be repaired before the placenta is removed, but I see no
special advantage in selecting this time. Lacerations are
either complete or incomplete. The former extends com-
pletely through the perineal body and the sphincter and
muscle and sometimes for a certain distance up the anterior
wall of the rectum, giving rise to a cloaca into which both
vagina and rectum open. The incomplete laceration does
not involve any of tlie rectal tissues and represents the lesion
with which we have to contend in the vast majority of cases.

The extent of the laceration can not be determined b^ a
hurried inspection of the external genitals, but we must make
our examination under the command of a good light, widely
separating the labia and wiping away the blood from the pos-
terior vaginal wall, make a thorough inspection, and we will
frequently find a laceration extending an inch or more into
the vagina or posterior wall and usually a little to one side
of the raphe, sometimes on both, and of varying depth. Prep-
arations should be immediately made for the repair of the
laceration. The instruments needed are a half-dozen pair

622 FIFTY-FIFTH ANNUAL SESSION

of artery forceps, a needle holder, scissors and a short full
curved needle. These having been sterilized, with a few
pledgets of gauze, the patient is turned crosswise the bed, the
hips down close to edge and each foot resting in a chair. The
knees are to be held by assistants and operator seated facing
patient. The external genitals are now thoroughly cleansed,
the labia separated and a small pledget of gauze is passod
into the upper vagina to obstruct the flow of blood and give ai
clean field for operating. We can now get a good view of the
laceration, and using chromicised catgut as suture material,
the first stitch is passed near top of the laceration. The needle
entering a quarter of an inch from the margin of the wound
is carried down under the base of tear and emerges at a cur-
responding point on opposite side. Each successive suture
is passed in the same way, and the ends caught by pair of
artery forceps and held by an assistant until the cutaneous
margin is reached. The rectum is protected from puncture
while passing the sutures by introducing a finger of the left
hand into the rectum, preferably the ring or middle finger,
so as to keep as clean as possible the index finger. The iru-
tures are now to be tied, beginning with the topmost one, and
avoid tying tight enough to produce tissue necrosis. After
the internal sutures have been tied and the ends cut we pass
one or two sutures on cutaneous surface of perineum going
well down into the body of the perineum so as to secure ac-
curate coaptation.

The complete laceration is very rarely met with. I have
had this complication to contend with in but one case only, a
face presentation in a primipera with instrumental delivery.
The laceration entered rectum and extended upward for an
inch or more. The rent in bowel was first closed by continuous
suture of fine chromic catgut beginning at top of tear and
included all the tissues of rectum down to the submucosa,
care being taken not to enter the bowel. The wound was now
converted into an incomplete laceration and treated as such,

N. C. MEDICAL SOCIETY. 623

care being taken to carefully approximate the torn ends of
sphincter.

The after treatment in these cases is simple. The bowels
should be kept quiet until the third day and the genitals kept
continuously covered by gauze pads wet in bichloride solu-
tion. Catheterization is unnecessary. Douchies are not in-
dicated and the stitches drop out spontaneously.

624 FirxY-riFTH annual session

THE THINGS THAT KILL WOMEN IN CHILD-
BEAEI^^G, AND HOW AND WHY.

BY H. D. STEWART, M.D., MONROE, N. C.

Mr. President and Brethren of the Medical Fraternity of
North Carolina: — My experience of ten years in the practice
of medicine and my observation for many years impel me
to the duty of entering a most solemn protest against the ig-
norance and carelessness through which so many lives are
sacrificed each year by the avoidable, preventable death of
the child-bearing woman.

In the first place let me lay down certain premises. Preg-
nancy is not a disease. It is distinctly a physiological pro-
cess. Labor is not a disease. It is a physiological act. Be-
ginning with a woman normally organized and constituted
and continuing through pregnancy and confinement with
such management and such prophylactic treatment as the best
medical and obstetrical skill will afford, death should come to
no woman in pregnancy or confinement, unless it should come
from some intercurrent disease in which child-bearing is not
directly concerned.

Not even should any pathological condition arise from
child-bearing per se.

It was not intended that woman should be any but a nat-
ural creature.

If the pregnant woman could but use the wisdom of the
brute, pathological changes and dangerous diseased condi-
tions would not come with her approach to motherhood.

Parturition is that progressive process in the child-bearing
life extending from the beginning of labor to the time the
uterus is cleared of the afterbirth.

The puerperium is that period of childbearing extending
from complete delivery to involution of the uterus.

Each of these three periods of childbearing is attended

N. C. ME^^lCAL SOCIETY. 625

with certain liabilities to disease and with certain dangers
to the life of the pi'egnant woman.

Most of these changes are due, however, not to infection,
but to pressure of the gravid uteras on the surrounding parts
or to insufficient elimination of the waste products of the
system.

iSTature seems to have endowed the pregnant woman with
a certain degree of immunity against infections and con-
tagious diseases. She seems especially to possess greater
natural immunity than the nonpregnant woman against ty-
phoid infection and tubercular infection.

On the other hand the reverse is true during the period
of lactation. During this period the vitality and the resisting
power of the mother are so lowered by the milk-forming and
the milk-giving process that she falls an easy prey to infec-
tious diseases.

Especially liable is she to tubercular infection. Conse-
quently she should secure more sleep and rest, more whole-
some, easily assimilable food and more oxygen and sunshine
than in any other period of her life.

I shall discuss in a specific way the chief dangers to the
childbearing woman autogenetic or arising within herself and
peculiar to her alone.

These troubles are such as are connected with childbearing
solely.

■ I shall discuss in a generic way the chief dangers hetero-
genetic to the childbearing woman or such troubles as are
brought to her from outside influences.

In the former class I would place puerperal eclampsia, pla-
centa pnvvia and exhaustion from difficult or protracted labor.

In the latter class I would place puerperal fever, post-
partum hemorrhage and long, difficult labor, neglected
through carelessness or ignorance.

These four troubles and these alone — eclampsia, hemor-
rhage, exhaustion from neglect and puerperal infection —

'626 FIFTY-FIFTH ANNUAL SESSION

are directly concerned and directly responsible in the death
of the childbearing woman.

Of the four the most important by far is eclampsia, be-
cause it is at the same time the most common and the most
fatal.

Eclampsia — Causes — Predisposing. — Excessive eating of
nitrogenous and carbonaceous foods. Excessive ingestion
and deficient elimination. Constant irritation of the kidneys
by overwork and by strong stimulating waste products that
must be excreted by this route cause an acute inflammation of
these organs.

The mother overloads and overworks her vital eliminative
organs and pathological conditions arise as a consequence.
She eats very heartily. She lives a sedentary life, she fails
to drink sufficient water daily, she neglects to stimulate the
skin to action by hot baths. She fails or even refuses to take
outdoor exercise to stimulate her eliminative organs and to
tone and strengthen her nervous system and her muscular
system.

She becomes chock full of poison. Her face swells, she
becomes blind, but still she sits around and eats. Her ig-
norant husband lets all go by without a thought of the dan-
gerous pathological conditions that are about to cause the
wife's death. He neglects to call a physician or even to think
of one until his wife suddenly has a fit. And often at this
stage the services of the most skilled physician can be of no
avail. The woman is so intensely poisoned and the elimina-
tive organs so refuse to act that nerve and muscle sedatives
and the most rapid eliminants utterly fail and the patient dies
in spite of all.

The pregnant woman has laid the foundation for eclampsia.
She has predisposed herself to the disease. She has stored
up the exciting cause.

The added excitation of the reflex labor act touches off the
powder and a series of violent, depressing, shocking, killing,
convulsive explosions occur at intervals.

N. C. MEDICAL SOCIETY, 627

The husband is guilty of criminal negligence because he
has not employed a competent physician to advise and to pre-
pare his wife for this trying ordeal of bringing a human
being into the world.

He could have had her urine thoroughly tested and all
cause and danger of puerperal convulsions could have been
removed.
. The best way to cure eclampsia is not to let it occur.

How does eclampsia kill the childbearing patient ? Urae-
mic poisoning acts on the motor nerve endings, producing
puerperal convulsions. The uraemia that causes the uncon-
trollable convulsions also paralyzes the life centers of respi-
ration and heartbeat, and death ensues.

Eclainpsia occurring before labor or during pregnancy is
hard to relieve because we have a physiological and a me-
chanical condition which obstruct and hinders very much the
work of securing good elimination, and thus rapidly removr
ing the cause of the convulsions.

Aside from the increased work of excretion occasioned by
the process of gestation there is a natural hyperaemia', or con-
gestion of the kidneys, which can not well be equalized except
loy removal, of the contents of the gravid uterus. : .'

Eclainpsia; occurring after labor is well in progress is easi-
est relieved because delivery soon comes naturally or ' caji
readily be effected, and the increased tension which the laTsor
act has! caused is removed, thereby greatly lessening the irri-
tatioii t>f the nerve centers.

Eclainpsia cording on several hours after delivery is the
most dangerous and the most fatal of all because it mean?
very grave pathological changes in the kidneys that are often
beyond remedy, and a weakened patient of lowered vitality
to work upon.

- The second dangerous, often fatal, trouble connected with
childbearing. per se is placenta praevia. ,•

Causes. — Ectopic, attachment of placenta from the begin-
ning of its development, violent contractile movements of the

628 FJFTY-L'IFTII ANNUAL SESSION

uterine umscular walls from muscular effort in lifting tubs,
water-pails and other heavy objects. The pregnant woman
may detach the placenta by reaching above her hanging pic-
tures or curtains, thus contracting the walls of the uterus.

She may throw the placenta loose from its normal attach-
ment by staying on her feet too long and too much in the pur-
suit of social functions. She may subject herself to the jar
of a wagon or a buggy over rough roads, or of a railroad car,
in traveling from place to place.

The terms placenta prsevia mean afterbirth out of its nat-
ural way or place.

Its natural place is in the upper segment on the posterior
or anterior wall of the uterus. When the placenta is so out
of place as to overlap slightly the internal os before the os is
dilated it is partial or lateral placenta praevia. When the
body of the placenta entirely covers over the internal os it is
central placenta praevia. Endometritis and multiparity are
supposed to be predisposing causes of placenta prsevia.

How does placenta praevia kill the patient ? It kills her
by fatal hemorrhage, either coming on suddenly and unex-
pectedly and being so excessive as to cause death, or by several
hemorrhages occurring at intervals and within a period of
some days or weeks, and ending up with a regular draining of
the life-blood.

When the hemorrhage comes on in great abundance without
premonition the skill of the very best obstetrician is often
taxed to tJie utmost, and even when he is near at hand,
promptly secured and does his best, his services are sometimes
of no avail.

The sudden, excessive cases are apt to be due to central
placenta praevia.

How often is a pregnant woman, apparently in the pink of
health and free from all harm, ushered at once into the pres-
ence of death. On the other hand, when the hemorrhage oc-
curs at intervals for days or for weeks, the husband may be
guilty of criminal negligence in not calling a physician

N. C. MEDICAL SOCIETY. G29

promptly. The physician called may be guilty of criminal
neo'lio-ence or of criminal ignorance by temporizing and tam-
pering with dangerous conditions.

It requires knowledge, skill and nerve to do a rapid prema-
ture delivery or a rapid delivery at term in the face of a
stubborn placenta pripvia hemorrhage.

When a pregnant woman discovers the slightest hemorrhage
her husband or whoever is responsible for her should call a
competent physician at once. She should be placed under the
very eyes of a good obstetrician, either near his home or office
or in a good hospital, and in either event near a good con-
sultant obstetrician. She should never be left to her fate far
away in the country.

The busy practitioner should never allow his rush of busi-
ness or his eagerness for business to lead him into criminal
negligence, with the sandy hope that nature will take care of
the case and he will get the credit and the pay. Many a wo-
man has lost her life through the delay and the carelessness,
not to say ignorance, of her physician.

The third trouble that sometimes kills the childbearing wo-
man is post-portion liemorrhafic This is hemorrhage occur-
ring after delivery.

Causes. — Indiscriminate use of ergot, chloroform and some
other drugs before delivery; anatomic, noncontractile condi-
tion of the uterine muscular wall ; exhaustion and paralysis
of the uterus from prolonged labor or from excessive use of
ergot and other drugs before delivery, resulting in a boggy,
relaxed condition of the organ.

Then again some patients die because no physician is at
hand in time or because the doctor called has not the neces-
sary knowledge and skill, or has not the necessary remedies
and appliances to stop the hemorrhage.

The Fourth trouble that kills the childbearing woman is
puerperal fever or infection, or more particularly puerperal
septicceniia.

Cause. — Direct cause is infection with the streptococcus

630 FIFTY-FIFTH ANNUAL SESSION

germ, resulting in a general systemic blood poisoning. This
infection is heterogenetic and comes from the carelessness and
ignorance of the midwife, the nurse, the doctor or of the pa-
tient herself, or from previous introduction of the strepto-
coccus into the vagina or uterus by nurse, patient, doctor or
husband.

Predisposing cause — lowered vitality and lowered resisting
power of the patient from any cause — poor nutrition, exces-
sive, hemorrhage, diseased endometrium, devitalized blood
senim, etc.

The source of the infection may be decaying, fermenting
membranes, blood clots and other debris left behind by the-
midwife or the doctor. She dies by systemic blood poisoning
or septicaemia.

Tlie last trouble we shall notice is death of the childbearing.
woman by exhaustion during labor or just after a long, diffi-
cult labor.

Many a woman has lost her life while an ignorant, pre-
sumptuous, pretentious midwife sat by dipping her snuff or
smoking her pipe, waiting for nature to take care of the
patient.

There is no excuse for death by exhaustion in a woman
otherwise normal. Death from this cause occurs where a mid-
wife has attended or where a competent physician has been
called too late or where from some other cause delivery haa-
been too slow.

Summary.

There should be a State law requiring every midwife tO'
stand and pass a good examination on anatomy, physiology,
obstetrics and obstetric nursing.

Every husband of a pregnant woman or whoever is respon-
sible for the M^elfare of the childbearing woman should be re-
quired by law to call an honest, competent physician in any
case of abortion, or in any case of pregnancy even that seems-
to be progressing naturally. This physician will, of course,.

N. C. MEDICAL SOCIETY. 631

use all precautionary measures necessary to prevent death by
disease or by accident. An abortion should be considered as
of as much or more importance than a full-term labor because
the patient is more liable to hemorrhage and to infection.

Criminal abortion should be detected and prosecuted with
the limit of the law, and the law should know no bounds in
these cases.

We note that four troubles and four alone connected with
childbearing per se cause the death of the mother. These are
eclampsia, hemorrhage, prepartum or post-partum, puerperal
septicaemia and exhaustion. These can all be traced directly
or indirectly to ignorance and carelessness on somebody's part.

1^0 doctor nor midwife who is not prepared to meet and to
take care of these four troubles should be allowed to practice
midwifeiy. There should be medico-ethical and medico-legal
regulations to meet each case in which a woman's life has been
uselessly sacrificed.

632 FIFTY-FIFTH ANNUAL SESSION

A MOXSTROSITY

BY J. U'. NKAL, M.D., MONROE, N. C.

On Jinie 26, 1907, I was called to attend Mrs. W. Found
her in the first stage of labor. Presentation vertex, O. L. A.
Progress perfectly normal. After about one hour a girl,
weighing six and one-half pounds, well developed and per-
fectly normal in every respect, was born. The uterus did not
come down at once in size as usual. Upon examination found
that there was another foetus, though evidently much smaller
than the first. Presentation, breech, S. R. P. After some
twenty minutes pains came on ; membranes ruptured spon-
taneously ; hips delivered in a few minutes ; body descended
rapidly and rotation effected. There was not the least stop
in the expulsion until the entire fa?tus was expelled, when, to
my astonishment, I found that it had neither head, face nor
arms. There were apparently no cranial, facial or even cer^d-
cal bones ; no eyes, ears or nose. Just above the upper end of
the sternum there was a small cleft bounded above by a small
cartilaginous ring, rather angular or pointed at the top, giv-
ing the cleft a triangular appearance. This cleft we judged
to be an abortive effort at a mouth. On either side and a
little back of this cleft there was a small lobe almost perfectly
spherical, one about three and the other about five lines in
diameter, attached by small pedicals from one to two lines in
diameter. The upper end of the trunk was rounded off
smoothly except for the rather abimdant and loosely adherent
skin, Avhich was covered with hair. There were no marks
pointing location of eyes or nose, and the two small lobes on
the sides of the cleft the only suggestion of ears, and there
were no meati at or near them. At the points on each sido
of the trunk where we should look for arms there were nd-
appearances of any attempt at arm-formation, but instead just
at these points there were small dimples. The remainder of
the bodv seemed normal. Sex, female. Genitalia well formed

N. C. MEDICAL SOCIETY. 633

and normal. Lower limbs well formed and normal except the
feet. Each foot had just four toes. The toes on the left foot
were normally in line, hut on the right foot the great toe wan
placed so as to come more in opposition to the other three like
the thumb. The foetus was kept alive until delivery, of course
through the cord, but I noticed no movements of either limb or
any part of the body after expulsion. There was no pulsation
of cord nor effort at respiration. Weight of fcctus two and
one-half pounds.

There was one placenta but two amniotic membranes. The
cord was small and had its origin near the center of the pla-
centa and near the origin of the cord of the other fa?tus. The
cord was very tortuous, ran along on the surface of the pla-
centa to its margin and then was continuous with and at-
tached to the membranes for about three inches further.

I forwarded the specimen to the National Museum, Wash-
ington, 1). ('., and received the following report from Dr. T.
T. Russell Assistant Surgeon U. S. A., who reported as fol-
lows: (Report herewith attached.)

13584. Contributed by Dr. John W. Nenl, ]\Ionroe, X. C.
Omphalosite.

Omjjhalositic foetus weighing 2.5 lbs. ; one of female twins born at
term. The autosite weighed G:5 lbs. and was normal, born alive and
continued to live and grow.

The omphalosite shows the following anomalies: some inc-rease of
connective tissue, though but little oedema ; one large lacuna beneath
scalp; small skull; rudimentary upper limbs, which do not appear
externalh'; persistence of facia, foetal processes; wide open mouth; ab-
sence of eyes; ears represented by tags of skin; small thoracic cavity
but absence of heart; lungs rudimentary and no j^leura; absence of
pharynx, oesophagus, diaphragm, stomach, duodenum, liver and pan-
creas ; portion of intestine one inch long blind at each end ; another
portion of intestine blind at beginning, and ending at anal opening
and following largely the median line; spleen pYesent, as also uterus
and right ovary; external genital organ well developed; allantoic canal
bladder well marked but kidneys not made out: club feet and anoma-
lies of toes.

At this date, nearly twelve months later, the twin sister is
still living and growing nicely.

634 FIFTY-FIFTH AX:?sUAL SESSION

SOME OBSTETRICAL MONSTROSITIES IN COUN-
TRY PRACTICE.

BY G. L. SYKES, M.D., SALEMBURG, N. C.

Mr. President and Gentlemen of the Society: — In present-
ing this paper upon so broad a subject, there can be no reason-
able excuse for its shortcomings save mj inability to express to-
others in composition my knowledge and experience of which
I have had ample occasion to obtain some very interesting
facts in this branch. The old adage you remember, "Poor
folks abound in children and gourds," and of such my country
is rich.

However, the few gleanings that shall follow are some of
the early as well as late monstrosities of an eight years experi-
ence out in the country eleven miles from any other medical
assistance, and until recently not even phone service, to assist
you in early consultation in an emergency.

So, gentlemen, one main purpose in this paper shall be to
give our city and town brethren a short sketch of some of the
monstrosities out in rural districts as are being met with
daily by your less fortunate country brethren, and how we
meet them. Also as an individual or selfish motive, to gain,
that criticism, comment or commendation as this paper may
deserve, and as shall help to make me more efficient in the-
management of those difficult problems, quicker to diagnose
and more ably treat than I have done in the past. Also, if in.
this effort I may help even one physician to gain a similar
knowledge, or even stimulate one to a keener sense of duty in
those things, I shall feel doubly repaid for this effort for the
sake of humanity.

I can not in reasonable space and time do so broad a subject"
justice and cover every monstrosity met in my experience-
were I the best compositionist in expressing the most in the
lesser number of words.

X. C. MEDICAL SOCIETY. 635

Therefore I can only sketch a few which have called forth
much nerv^e, anxiety and self-confidence to handle alone, to-
gether with methods employed, treatment and results.

The first monstrosity I found to solve as a young doctor —
and I find it holds good in the general practice as well and
even haunts me until this day — is this :

How to Value My Services. How to value my services so
as to conform with that of other physicians of my county, and
how to make my services as efficient, or more so if possible,
and thereby gain my patients' highest esteem and respect was
the question; and this I considered the necessity to prompt
them to an early and much-needed settlement of accounts.

This difficulty, gentlemen, was due in great part to lack of
cooperation of physicians, but now our county societies are
aiding us all along this line, and especially our young doctors,
just falling in ranks.

By cooperation in society work we are better able to favor-
ably compare, value and estimate our own work and also to
better educate the laity to value and esteem our profession as
a whole.

Pardon me for thus, commercially and socially, digressing
from a strictly obstetrical problem. I will now consider my
first.

What is My Duty to the "To-he-motherf A physician
engaged by this class of patients has a most peculiar as well
as sacred responsibility. They will and rightly so, too, engage
our services three and four months prior to delivery. We
then are in a sense responsible for a normal travail and de-
livery, not that there shall absolutely no trouble arise, but in
the sense of preventive medicine there is much that we may
do; and if we are not alert to our duty we are deserved of
serious censure. In this connection I shall necessarily touch
on puerperal eclampsia as well as outline some remedies for
the "granny question."

If we are more appreciative of preventive than curative
medicine then, in this field, we certainly have a chance to do

636 riFTY-FIFTII ANNUAL SESSION

some most noble work. If we are not more appreciative of
preventive medicine than curative, then we do not measure
np to the highest professional spirit. In the spirit of pre-
ventive medicine I beg for the sake of suffering humanity
that each of us carefully examine ourselves to see if we have
been measuring up to the requirements of this class of pa-
tients.

Our services having been thus engaged we give them no
further thought or consideration until the summons comes to
hasten to the woman in labor, and we forward march, only to
find, i^erhaps, our patient in hard convulsions, should be, it
seems to me, sufficient evidence that we are unworthy of the
honors entrusted to us, and that we have actually cast a reflec-
tion upon our profession. Such a physician is unworthy of
even the respect and honors granted the ''granny" woman, for
even she shows more sympathy, care and interest in her pa-
tients than this. Our failure just here as physicians may be
one of the great reasons as to why such a great per cent of
labor eases are entrusted to the "granny" instead of to the
physician.

Let us then use this magnet and draw the greater number of
cases in the channels they should go and thus, by better skill
and knowledge, save so many mothers the needless disasters
they are daily meeting; and with our skill and knowledge
rightly and justly used we will easily and rightly eradicate
the "granny" problem.

If the etiology of eclampsia is due to the retention in the
system of urea, carbonate of ammonia, microbic infection or
to whatever retention in the system it may be, it is evidently
for want of proper elimination of those products by kidneys,
liver, or perhaps both, and might tliereby be prevented if
looked after in time. Then, in such cases as occur imder the
"granny" woman's care and to which our services are de-
manded, let us have so clear a record that we can hold up to
the family and friends (and at such a time there are many)
that shall plainly show the advantage they might have had

N. C. MEDICAL SOCIETY. 037

had they eiujjloyed a phAsieiaii in the case in due time to have
prevented this trouble.

The kidneys in pregnancy are very prone to become ineffi-
cient to the extra (hities of excreting the excrementitions mat-
ter from both the mother and the foetus, by reason of ne-
phritis, increased intra-abdominal pressure, or direct pressure
upon the ureters ; if then the physician will bear in mind that
the kidneys may be diseased, and yet functionally sufficient,
or that they may be healthy anatomically, but functionally
insufficient for their increased work, and he is alert to help
his pregnant patient as he should, may he not do much in the
prevention of grave troubles ?

I will not dwell on this important subject of preventing
puerperal eclampsia as this subject has been or is to be well
discussed by other papers directly on this subject.

There are two other subjects I wish to dwell on under pre-
ventive medicine in obstetrical practice. [N'ot the disease
per se, but the evil consequences of these diseases, and as such
were monstrosities in my practice. I refer in this to gonor-
rhoeal infection and diabetes mellitus, and illustrated by re-
port of cases.

Case No. 1. — Mrs. N. L., age 30. On January 13th I was
called to see this lady in labor. I arrived about 11 a. m., and
found she had been in labor all the night and had been losing
the amiotic fluid all along for three or four days. She states
further that she had had quite a profuse leucorrhoeal discharge
for seven or eight weeks, with the most intense itching imagin-
able, both in vagina and externally; but that the discharge
during the last few days has not been the same color as before
nor as regular, but more wateiy-like and only two or three
times a day. She was then having pains about every thirty
minutes and said she itched so bad she could hardly endure
it. As soon as I could give her a bath of external parts and
prepare my own hands I made digital examination, and found
that the entire vaginal vault as well as the vaginal mucous
membrane of the cervix was thick and richly beset with rough

638 FIFTY-FIFTH ANNUAL SESSION

dry pimples, so rough and dry was it that I can not better
compare it than to the dorsal surface of a beef's tongue. I
found in her past history that she had been anaemic, stout, and
weighed 200 pounds and over until two years ago, w^ien she
gave birth to her first child ; since that time she has not
weighed over 156 pounds. This child was a full-term child,
stillborn and bones of head only partially formed, but head
was one-third larger than normal she states, and was like a
sack of water. (I judge hydrocephalus.)

Considering the best history I could get of the lady and that
of her husband also, and from the fact that it was a quiet
country home, and after suppressing my first opinion from
my digital examination, I jumped at the conclusion that I
had a case of "Hirst's" so-called colpo-hyperplasia cystica, in
which he describes a hypertrophed condition of the vaginal
mucous membrane, thickly beset with retention cysts, in which
the mucous dries away and is replaced with pus. This case
■progTessed under my own eye for three hours only to worry
the mother and no progress, even with the aid of ten grains of
quinine. At this time I began the use of stimulants, such as
hot coffee and spirits. Four hours passed and no progress
made. My forceps were sterilized and the work soon and
■easily accomplished. . . ■;

As before stated, my suspicion w^as greatly aroused upon
my first examination, but in all my infirmary practice while
in college among the low classes I never met with such a con-
dition as this, even where we knew specific infection tvas
present in the majority of this class of cases. I purposely
used no specifics in the dressing of the child's eyes to aid me
in clearing up the diagnosis, which it promptly did in a couple
of days, for ophthalmia neonatorium was beautifully devel-
oped and promptly disappeared upon the application of a
two per cent solution of nitrate of silver. On the 16th, fol-
lowing, fever developed, 102, slight rigors, nausea, coated
"tongue and much tenderness over the pelvic region, with some
aching and characteristic odor about the bed. I was called,

N. C. MEDICAL SOCIETY. 639

and not having the time that evening to give local treatment
myself I gave calomel, followed with free saline purgation,
quinine and febrisol for fever and pain. I had the nurse to
give a hot S. S. douche and put a hot poultice over the lower
abdomen.

On the 17th I was sick and could not go and sent perman-
ganate of potash to use in the douche morning and evening.
On the 18th I went to see patient and found temperature 103,
with above symptoms plus a very tender left thigh, some less
nausea and a better appetite. We prepared and gave an intra-
uterine douche, very low hydrostatic pressure, using first the
noiTnal saline solution, then the iodide of mercury solution
1-3000, followed by a normal salt solution; continuing the
internal treatment and a liquid diet. On account of an attack
of lagrippe I was unable to do any practice, and hence the
case was not seen any more until February 12th, when I made
my next visit, only to find upon a vaginal examination • a
nicely- developed case of piosalpinx. I thought it my duty to
tell her the seriousness of her case and explain to her the im-
perative need of an early operation which we did, and was
accepted by her, and I made intercession for her with a sur-
geon at a hospital and she was sent to him on the 14:th with a
full history of the case and my diagnosis. This good doctar
did not operate at all for the following reasons : She had no
fever, heart weak and the pus sack he says had in the mean-
time ruptured and was walled off, and hence no imperative
danger since general improvement seemed to be in progress ;
therefore he thought best to take the conservative plan. On
the morning of the 22d her nurse went in to see her ; she stated
that she had taken a good night's rest, felt as good as the
evening before, when she had written her husband that ^le
was improving fast and hoped in a few days to be able to
return home well, and with some greetings to her family and
friends. The nurse left her to return in one hour only to find
her dead.

Gentlemen, I feel that I fell short of my duty in this case

640 FIFTY-FIFTH ANNUAL SESSION

in that I did not accept my first convictions and begin to limit
other excuses and causes for the conditions I found upon my
first digital examination. I feel like that had she been prop-
erly douched and treated during the four hours I was waiting
for and trying to help nature to start up labor, that perhaps
all this fatality could have been prevented. This my con-
science censures me with reproach and I have promised to
profit for future benefit by this error. And I feel, too, that
my good friend and surgeon is none the less in fault for this
fatality for not having operated early. If it was ruptured
and walled oif, then drain ; if not, then remove. But let us
all profit by our unavoidable mistakes and try to make as
few mistakes to profit by as possible.

Troubles, as you know, always come in triplets ; so follow-
ing this case I had another very peculiar and rare case. Mrs.
P. F., age thirty-six, developed symptoms somewhat similar
to those given in above case before delivery, together with
pyrexia, sore mouth, constipation, freely-acting kidneys and
cough. Being mindful of the above case I gave husband a
most rigid examination and was unable to satisfy myself as to
any specific trouble. Having examined patient I decided that
it was poor elimination due to cold and biliousness, I gave
her some eliminative treatment and an iron tonic with some
digestive ferments ; asked that she report in a few days if not
doing satisfactorily, and also to send me the quantity of urine
voided in twenty-four hours and a sample of same. This she
did not do, and I heard no more of this case for four weeks,
when I was summoned in haste to see the lady supposed to be
in labor. I knew this was a false alarm from my previous
visit and history. But upon my arrival I found one of the
most miserable beings I have met in all my life's practice.
Wringing, twisting hands, scratching and crying can't lie,
can't sit, out of breath, and in every way miserable. Well, I
was most miserable, too, for I could not easily decide which
was really my duty, to abuse her and her husband for not
obeying my directions on first visit, or to sympathize and try
again to relieve.

X. C. MEDICAL SOCIETY. 641

I looked at the miserable being', examined her in eyery
way, and fonnd that she Avas not in labor, bnt that she was at
least a month to term according to all symptoms and her own
eonnt. I obtained a specimen of her nrine and asked her hus-
band to come to my office at once and I would tell him what
we had to do. After giving my patient a hypodermic of mor-
phine I hurried to my office and examined the specimen of
urine and found it very rich with sugar. So this cleared the
diagnosis for me, and I told her husband that to save her life
I thought best to produce miscarriage, and to do this was
rather more than I cared to undertake by myself and that I
wanted consultation. This being granted, I sent for Dr.
Holmes to meet me next morning. He came, examined and
ao-reed with me upon my diag-nosis and proposed treatment.
All necessary arrangements were made, we thoroughly
douched vagina with mercuric iodide solution 1-2000, forcibly
dilated the cervix to size of dollar with instrument and intro-
duced a sterile catheter through cervix into uterus, packed
vagina lightly and left patient for six hours to await results.
Upon our arrival in ten hours we found that no progress had
been made. We then resorted to the usual uterine stimulants
and worried with the patient trying to induce labor till next
day, making twenty-four hours effort ; but all in vain. So we
proceeded to deliver with forceps, which was accomplished
with no little difficulty on account of an anterior parietal
presentation. This, however, was accomplished, foetus dead,
but mother made a slow and steady improvement for seven
weeks, when I gave her careful directions about diet, etc., and
discharged the case, there being no glycous urea at this time.

Since writing up this case I called to see this lady to obtain
her present condition. She had, as soon as discharged seven
weeks after delivery, resumed her regular diet and general
household duties and was, on the 12th inst., when I called for
this history, preparing to cook a big farmers' dinner.

I asked her to allow me another urinary analysis, and if she
would I thonglit from her general appearance that she had
41

642 FIFTY-FIFTH ANNUAL SESSION

best come with it and let me examine her generally, for she
looked awfully bad. She kindly consented and came with h
specimen of twenty-four hours urine. I find she is voiding
about 59 to 60 ounces per day. Urine showing the following
analysis, viz : Color, pale yellow ; reaction, neutral ; sp. gr.,
1.008 ; no sugar ; a little trace of albumin; very frequent mic-
turition; pulse, 100; hard and incompressible, flatulent indi-
gestion ; general weakness and drowsy feeling ; much pruritus
at menstrual time, which is very scanty, but profuse leu-
corrhcea. With this brief history I am quite sure now that I
have a case of nonexudative nephritis and that my diabetes
mellitus in the pregnant stage was only an aggravated condi-
tion of a preexisting nephritis.

The lesson then I have learned and hope to impress by the
two above cases is this : Anaemic and gonorrhoeal infection so
closely simulate the an?Rmia and symptoms of diabetes melli-
tus in pregnancy that it should demand the most careful at-
tention of the physician, and that an early differential diag-
nosis with the proper treatment will do much in the prevent-
ive sphere of medicine, and it will save much needless suffer-
ing as well as lives.

My next and last monstrosity for consideration in this paper
is puerperal paralysis. As my paper is now too lengthy I will
make this case as short as possible. This was a case I had
given very careful attention for two months prior to delivery,
and while I lost the mother I am quite sure I have a living
child as the result of those efforts.

Mrs. A. H., age twenty-six ; mother of three children be-
fore this one. I had attended her in all of them and all of
them were normal labors except the second labor, which I had
to deliver with forceps on account of partial uterine inertia,
due to unusual size of child, over-disteution of uterus, child
weighing twelve pounds. Some weeks prior to the fourth
labor she had been complaining of intense headache, drunk
feelings, buzzing in the ears, cramp in the legs and a general
(edematous condition, and as some authors class dropsy by

N. C. MEDICAL SOCIETY. 64:3

locality, thus: that if in the entire system, kidneys at fault;
if in the feet, the heart is at fault, and if in the abdomen, the
liver; hence, in this case, I diagnosed inefficient kidneys and
was looking for eclampsia to develop. The facial neuralgia
and intense headache I could not relieve ; it lasted her three
■days prior to, during and after delivery. Morphine in one-
fourth grain doses would give only moderate relief. I am
quite sure she had the quickest and easiest time she ever did ;
she only had three real hard labor pains and the work was
complete. I noticed after delivery for thirty minutes she
seemed to be easy, but she soon began to complain of that
headache more and more. For fifteen minutes or more she
seemed to be semi-conscious. This passed off with a clear mind
and the clearest of headache she had been for days ; but soon
a profuse hemorrhage came, and she asked for food soon after
this hemorrhage ceased. I remained with the patient for
four hours after delivery expecting eclampsia, but no further
symptoms except the headache developed, for which I gave a
cerebral sedative of chloral, bromide, gelsemium and opium.
This was to be repeated every three or four hours. This was
on Saturday morning, and no further report till Monday
morning. This report was that she was all right except very
restless and could not sleep and still had some headache. I
directed the use of this cerebral sedative and called to see her
in the evening. She was given one dose of the sedative a^ 9
a. m. and grew worse, and at 11 :30 the dose was repeated, and
then she rested better ; but by 1 p. m. she Avas taken with wor(i
blindness and could not speak what she wished to, but fhe
opposite. She had become bloated in the face and the bowels
had not moved since birth of child ; temperature normal, and
pulse fairly good. I stopped the sedative, gave calomel and
seidlitz powders. I was again summoned that same evening
at 11 o'clock and found her entirely unconscious, speechless,
ptoses of left eye and pupil diverged down and to left ; pupil
of this eye widely dilated and that of the right partially di-
lated and right deviation. Sensation in right arm and leg
lost and partial if not complete lost motion. Comatosed con-

641 Klb'TY-FIJ- rU A>;XUAL SESSIOiS:

dition gradnally progressed till life expired in about forty-
eight hours. This condition I attributed to intracranial hem-
orrhage; but just the cause of intracranial hemorrhage I can
not fully satisfy my mind, unless it was the hard labor in
some previous deliveries causing some aneurismal pressure
and at this labor ruptured ; and if so, then this is one good plea
for early instrumental interference in slow, hard and pro-
tracted labors from whatever cause.

X. C. MEDICAL SOCIETY. 645

HISTORY OF CASE OF IIYDATIDIFOEM MOLE.

BY J. M. WILLIAMS, M.D., WARSAW, X. C.

Among the first cases of my obstetrical experience I was
called to see a woman of whom it was said she was dying
from hemorrhage. History indicated that she had been preg-
nant nearly three months ; that she had been suffering from
hemorrhage for seven weeks and using only such remedies
as the granny might offer during this time. Had given birth
to one or two children witliout difficult}' and with no indica-
tion of disease up to the present pregnancy. Age twenty-
four. Shortly after conception it was noticed that the abdo-
men increased in size very rapidly, until now, at less than
three months from conception, inspection would indicate full-
term pregiiancy.

Bimanual examination proved only the presence of a boggy
mass, no dilatation of the os, but a constant oozing of blood
that Avas threatening the life of my patient, with no discharge
of cysts that might be expected.

Without a consultation arid with no experience of this kind
I did not want to terminate pregnancy; but it appeared that
something must be done at once or my patient would bleed
to death before any consultation could be gotten. So I at
once prepared to tampon the vagina. First packing the cervi-
cal canal as tightly as I could with sterile gauze, I then
packed the vagina and put on a T bandage.

The hemorrhage was completely arrested, and after twelve
or fourteen hours active labor pain came on. I removed the
tampon and with it an enormous mass of cysts, perhaps
nearly as large as a man's head, but no embryo could be
found. The cysts varied in size, some as large as a chestnut.

The diagnosis of this rare disease is sometimes difficult
and depends on the discharge of cysts that can be recognized,
also on the hemorrhage with history of rapid growth of
n terns.

646 FIFTY-FIFTH ANNUAL SESSION

The treatment of it is immediate removal, as early as it
can be recognized, by means of the aseptic finger.

The curette is said to be dangerous on account of the thin
walls of uterus, which this growth may have penetrated, even
into the abdominal cavity.

There is an immediate mortality of ten per cent from this-
disease, while fifty per cent develop deciduoma malignum,
or chorionic epithelioma, destroying life in less than twelve
months. Hence the necessity for early removal has been
urged by Williams, of Johns Hopkins ; also that the patient
be watched for months after labor for the development of this
most terrible disease.

N. C. MEDICAL SOCIETY. 641

HYDATIDIFOEM MOLE (MYXOMA CHOEII) WITH
. EEPORT OF CASE.

BY J. B. CKAXMER, M.D., WILMINGTON, X. C.

In writing this paper it has not been mj purpose to touch
upon the histology of the chorion, nor to dwell at length upon
the pathology of the hydatidiform mole.

I do not claim to be giving you an original treatise ; this
is largely a resimie of the subject, with the report of an in-
teresting case.

The degeneration (aside from the normal process of
atrophy) that may affect the chorion villi is of two kinds :
cystic and libro-myxomatous. This paper has to do with
the first — cystic degeneration of the chorion villi.

This pathological condition is characterized by hyper-
trophy of the chorion villi, and by their conversion into cysts,
varying in size from that of a millet seed to that of a gTape,
or even to that of a hen's egg, connected with one another and
with the base of the chorion by pedicles of varying breadth.
The ovum grows rapidly, with consequent expansion of the
uterus. There is escape of blood from the uterine cavity to
the vagina, and a premature expulsion of the ovum, which is
covered with small, transparent cysts. An embryo may or
may not be found.

There has been much discussion of this condition by reason
of the mystery which formerly surrounded its origin. Even
at so early a date as the sixth (<3th) century papers with no
very clear idea of its nature were written upon this subject.
DeGraaf held that the vesicles were mature ova, while some
authors thought that each one represented an early preg-
nancy.

It is probable that many of the extraordinary cases of
multiple gestation recorded in the early literature were in-
stances of the hydatidiform mole, as, for example, that of the

648 FIFTY- i'lFTH AXXUAL SKSSIOX

Coiiiitess of Ilagciiaii, who avus believe*! to lia^'e given birth
to three hundred and sixty-fi^■e (305) cnihrvo at a single labor.

Priestly goes so far as to quote (in reference to this case)
from a writer of that time, "that the Countess Margaret
brought forth at one time three hundred and sixty-five in-
fants— one hundred and eighty-two males, one hundred and
eighty-two females, and the odd one an hermaphrodite." This
as late as 1276 of our era.

Pepys even records in his diary that he visited the house
in which this remarkable delivery occurred, and saw the
brass platters upon which, according to a custom of the day,
the children were carried before the bishop of the diocese for
baptism.

Xumerous theories have been advanced as to the nature of
the lesion until Virchow, in 1853, stated as his belief that the
process was essentially a myxomatous degeneration of the
connective tissue of the chorion villi, and designated it as
myxoma chorii.

Marchand, however, in 1895, held that the essential feature
of the affection was to be found, not so much in the stroma
as in the epithelial covering the villi.

The process occurs at a time when the villi arc almost
equally developed over the w^hole ovum, before the third
month, and involvement of the whole villi is the rule. Some-
times the placenta alone is affected. In this morbid process
it is important to know that the cells of Langhan's layer and
the syncitium display an exuberant growth, showing a de-
cided inclination to penetrate uterine tissue ; therefore the re-
lation of myxoma of the chorion to syncitial cancers is quite
intimate, and in a large proportion of the latter growths
there is associated a cystic disease of the chorion villi. There
may be metastasis of the whole chorion villi without malig-
nant degeneration of the epithelial cells, or the chorion epi-
thelium may undergo malignant degeneration after metastasis.

Aside from the possibility of the development of a decidu-
onia malignum, the hydatidiform mole is a serious affection.

X. c. :medical society. 64-9

Dorland. for exanipic, noted a mortality of ten per cent
■\vitli the one liundrtd instances which he collected from liter-
ature.

As I said before, the prominent symptoms associated with
cystic degeneration of the chorion are :

First. — A rapid increase in the size of the uterus.

Second. — A discharge of blood, or bloody serum ; and

Third. — An escape of vesicles.

This last symptom is of rare occurrence, and the first is not
always typical, so that the clinical phenomena in the case of
vesicular mole do not always admit of a definite diagTiosis.

Xone of us cares to make a practice of reporting single
<3ases but, as few of us have an opportunity to see many lihe
cases, we may be pardoned for making occasional deductions
from our individual experiences.

A case which came to me a few months ago has awakened
my interest on this subject. Mrs. W., age twenty (20) ; fam-
ily history, negative ; personal history showed previous vigor-
ous constitution. Married ten months ; menstrual period hav-
ing been missed for five months. Slight hemorrhage, pain
and discharge having occurred once during this period, at
which time patient was kept in bed by her attending physi-
cian, under usual treatment for prevention of miscarriage.
August 30, 1907, I was called for the first time at 12 o'clock,
midnight, to what was reported to me over the phone as a
^'miscarriage case." Upon arriving at the house I was told
by a woman present that "it was all over." I found the pa-
tient flowing profusely, having already expelled a quantity of
grape-like masses. To be sure that the uterine cavity was
entirely emptied I made pressure above, and another large
mass of like character was expelled. The hemorrhage was
continuing to an alarming extent. Giving hypodermically 20
minims of ergot, one-thirtieth (1-30) of a grain of strychnine
and one-eighth (1-8) of a grain of morphine stilphate, I made
careful digital examination as soon as it was practicable. The
uterus was found nmcli enlarged, flabby, and the cervix patu-

650 PIFTY-FIFTH ANNUAL SESSION

lous. Small particles of the grape-like masses were found
adherent to the uterine walls. With lightest possible touch
and dullest rinsing curette I went over the walls of the uterus,
and washed out the cavity with weak antiseptic solution. The
hemorrhage was- almost immediately controlled.

The patient made a good recovery and is now in perfect
health, although still very much impressed by the information
I gave her as to the rarity of such cases^ seeming rather proud
of being, according to Madam Boivin, a case in twenty thou-
sand.

N. C. MEDICAL SOCIETY. 651

PUERPEKAL ECLAMPSIA.

BY E. F. STRICKLAND, M.D., BETHANIA, N. C.

Mr. President and Gentlemen of the Medical Society of the
State of North Carolina:

In answer to a request, coming from the Secretary of the
Society and from the Chairman of the Section on Obstetrics,
to present a paper at this meeting, I stated that it would he
my pleasure ''to hear rather than to be heard" on this occasion.

However, yielding to a sense of duty, I ask you, in the
same spirit, to hear me discuss, briefly, that old, old subject,
though ever new and of the keenest interest to the obstetrician
and general practitioner, viz, "Puerperal Eclampsia."

Puerperal Eclampsia is an acute disease, which may occur
before, during or after delivery. As its pathology is more
or less unsettled, its etiology theoretical, its treatment is
largely empirical. Without recounting the varied and many
theories advanced, both old and new, concerning its nature
and etiology, suffice it to say that it is now generally conceded,
I believe, that auto-infection during the pregnant or puerperal
state is responsible for the condition — the eliminative powers
of the kidneys and liver being principally at fault.

The functionating powers of these organs may be impaired
primarily as a result of accumulating toxins due to preg-
nancy or, the pregnancy may be added, as a complication to a
pre-existing parenchymatous degeneration of these organs.
A true nephritis may exist or may not. Albumin is usually
found in the urine, — casts frequently.

The pathological changes in the liver are now regarded as
more characteristic and constant than those of the kidneys.
Hemorrhagic hepatitis, fatty degeneration and disorganiza-
tion of the liver cells are found on post-mortem examination.

That plural births, a nervous temperament or heredity are
predisposing causes my own experience does not confirm.

652 FIFTY-FIFTH AXXUAL SESS[()X

I find that priini])ai"a are more frequently attacked than
multipara. Xatnrc's ineffectual effort to rid the system of
the excessive materies morbi, in consequence of the impaired
and sluggish functionating poAvers of the emunctories and the
stagnant channels of elimination, is an all-sufficient cause for
the gradual development of the eclamptic condition, or the
sudden outburst of the iit itself. The premonitory symptoms
are oedema of the lower extremities, hands and face; head-
ache ; dizziness ; a ''boring pain in the pit of the stomach" •
disturbed vision, sometimes amounting to blindness ; a capri-
cious appetite; usually constipated hovels; a diminished flow
of urine, which usually contains albumin.

Whether these symptoms come as the rattle of the rattle-
snake, and as surely speak of' danger ahead, or whether with
the suddenness of the spring of the cobra, and without warn-
ing, the attack is the same, and the struggle between life and
death is at hand.

The spasm once witnessed can never be forgotten, and there
is no mistaking tbe diagnosis. They last, usually, from one
to three or four minutes, when there is a complete relaxation
of all the muscles for an interval varying from a few minutes
to a few hours, w^hen there is a return of the spasm, if the
condition is unabated.

In the intervals between the attacks the patient is in a state
of partial or complete coma, depending upon the severity and
the number of the attacks. The number of spasms may vary
from one to one hundred.

Usually there are from six to thirty. Death is liable to
occur either during a convulsion or in an interval between the
attacks, — in the former from asphyxia, in the latter from the
combined effects of asphyxia and exhaustion.

It has been reckoned by worthy authors that one j)er cent
of pregnancies result in eclampsia, that 25 per cent of these
prove fatal to the mother and 50 per cent to the child.

The per cent of cases actually occurring, and this large
mortality rate have been much reduced of late years by d.

X. C. MEDICAL SOCIETY. 653

better imderstandiiiii' of the disease and the application of a
more rational and active plan of treatment than hitherto was
practiced.

The treatment will be spoken of under two heads, viz: (1)
Prophylactic; (2) Active. In no disease is the maxim more
true, perhaps, that ''an ounce of prevention is worth a pound
of cure'' than in puerperal eclampsia.

The urine should be frequently examined during the latter
months of pregnancy for the detection of the presence of albu-
min, and albuminuria in conneetion with the premonitory
symptoms already described, should lead to the employment
of a prophylactic treatment at once.

The diet should be restricted to milk, if possible ; the skin
should be kept active by hot baths, hot packs and friction;
systematic open air exercise should be instituted ; the bowels
should be kept in a lax condition by the administration of
Eochelle or Epsom salts, with an occasional calomel purge;
the kidneys should be kept active by the administration of an
abundance of the best and most reliable of all the long list of
diuretics, viz, plain, simple water; infusion of digitalis may,
also, be given if desired. Give Bashom's mixtiu-e or Tr.
of the per chloride of iron, for their diuretic and tonic effect.

This is all that can be done in the v.ay of prevention, and,
if in spite of this, the attack develops before, during or after
delivery, we are brought to the employment of what I have
designated as the "active treatment.'" Chloroform inhala-
tion should be practiced to lessen the severity and frequency
of the convulsions. Venesection should be employed to re-
lieve arterial tension and lessen the pulse rate. Morphine in
one-fourth grain doses should be administered hypodermically
and repeated as indicated.

Chloral in thirty-grain doses may be administered per rec-
tum, and repeated if necessary.

The attack occurring prior to delivery is usually amenable
to this plan of treatment, and the patient will go on to term.
If the case is intractable, however, pregnancy should be termi-

654 FIFTY-FIFTH ANNUAL SESSION

nated by dilating the os with the best dilator ever used,
namely, the fingers and thumb of the practiced hand, or one
of the various instruments used for this purpose, than which
none is superior to the invention of our own Dr. Lott, of
this city, the application of the forceps and the complete
emptying of the uterns.

The attack coming on during labor should be hastened by
the same mechanical means, for my experience teaches me
that delay here is dangerous to the mother and eminently so
to the child, and that nine times out of every ten the attack
will continue until labor is terminated.

In cases occurring subsequent to delivery, the active medi-
cinal treatment already outlined should be practiced, followed
by the eliminatives and tonics which, also, have been fully
described.

Before closing I wish to report the following interesting
cases which have a practical bearing upon this paper :

Case 1. — On June 10, 1907, I was called to see Mrs ,

primipara, at full term, who was suddenly seized with con-
vulsions soon after labor began. She had six convulsions in
eight hours, at the end of which time she was delivered of a
healthy child by the natural efforts.

The last convulsion immediately preceded the termination
of the second stage of labor. Her recovery was uneventful
and complete. There were long intervals between the convul-
sions, during which times the patient was rational.

Case 2. — On August 8, 1907, was hurriedly summoned to

see Mrs , multipara, who, on the morning of the fourth

day after confinement, suddenly complained of being blind,
and in a few moments had a convulsion. She had four
spasms within the next few hours, only partially regaining
consciousness in the intervals, passed into a state of coma,
from which she did not rally for several hours, but made a
complete though rather tedious recovery.

Case 3. — On reaching Mrs , primipara, to whom I

was called on January 13, 1908, I found her in convulsions.

N. C. MEDICAL SOCIETY. 655

The history elicited was to the effect that the period of gesta-
tion was complete, but that there had been no complaint of
labor pains. The first thing complained of was an acute
pain in the region of the stomach ; a few minutes later the
patient said she was blind, and immediately was seized with
a convulsion.

On examination, there was no dilatation of the os uteri.
On close observation I perceived that, notwithstanding my
efforts to control the spasms, they were recurring with syste-
matic regularity about every twenty to thirty minutes. De-
ciding that labor had already begun, and that the convulsions
were synchronous with the pains, I took up the task of artifi-
cial dilatation and delivery, which I was able to accomplish
after the elapse of several hours and the occurrence of as
many as twenty convulsions.

After an instrumental delivery of a stillborn' baby, there
was not another convulsion. The mother was in profound
coma in the intervals after the first convulsion, and did not
return to consciousness for several hours after delivery. Her
recovery was slow and tedious and reached through a period
of ninety days. There was some oedema of feet and puffiness
of face, indigestion, disturbed vision, headache, and albumin
and casts in the urine, in greater or less quantity, throughout
this long period of time.

She is now in perfect health. 'No analysis had been made
of the urine in any of these cases prior to delivery, as there
had been no subjective symptoms, and therefore prophylactics
were not employed.

The plan of treatment followed in these cases, with the
resultant happy issues, is fully set forth in the body of this
papei .

656 FIFTY-FIFTH AXKUAL .SESSION

PUEKPEEAL ECLAMPSIA WITH REPORT OF
CASES.

BY JOHN A. FERHELL, M.D., KENAXSVILLE, X. C.

Eclampsia is a word coming to us from the Greek language,
meaning to shine, or burst forth. PuerjDeral eclampsia has
been defined as ''an acute nervous affection," characterized
by convulsions, with loss of consciousness, occurring toward
the close of pregnancy, during or after labor, believed to be
caused by the irritation of the vaso motor centers, by retained
excrementitious substances." During the convulsions nearly
all the muscles of relation, and in fact those of organic life,
are contracted, and the fit is preceded, accompanied and fol-
lowed by a more or less complete suspension, for a variable
time, of the intellectual and sensorial faculties.

In a brief paper of this kind it is not possible to go imo
a detailed discussion of the various phases of puerperal ec-
lampsia. It may not, though, be impractical to mention
under some aspects of the subject a few^ salient points.

To begin with, we may say its etiology is still obscure. The
many theories advanced to account for its cause stand in evi-
dence of this fact. All we can say at present is that in the
body metabolism of mother and foetus certain excrementi-
tious substances are produced which are poisonous to the
whole body, unless rendered harmless and thrown off by the
excretory organs. The exact nature of these poisons is not
yet understood, but it is known that their cumulative action
gives rise to the eclamptic seizures. Being stored up in the
maternal blood, it is probable they serve as irritants to the
arterial walls, causing their sudden contraction. Resulting
from this, besides other phenomena, there are especially, cere-
bral disturbances and renal congestion. Kidney deficiency
more than deficiency of other excretory organs is responsible
for the eclamptic condition.

Infrequency eclampsia is seen once in about every three

X. C. MEDICAL SOCIETY. 657

hundred and twenty-five pregnancies. It occurs more fre-
quently in primiparte than in multiparse, and in multiple
than in single pregnancies. Weak or diseased kidneys pre-
dispose to it. As to time it is seen most frequently during
pregnancy, next in frequency during labor, and least in fre-
quency during the puerperium.

The mortality is variously stated by different writers.
Hirst gives it at fifty per cent if eclampsia occurs during
pregnancy or labor.

With regard to the symptoms and diagnosis only a few
words need be said. With the history known the condition
can hardly be mistaken. Though the attack may come on
abruptly without w^arning, there are usually prodromal symp-
toms, such as pain in the head and epigastrium, disturbed
vision, and scanty urine. K^othing special need be said about
the convulsions. It is noticeable, however, that though the
patient seems rational the greater part of the time, yet when
she recovers she has no recollection w^hatever of events which
occurred during and immediately preceding and following
the whole period during which convulsions occurred.

The probable causes of eclampsia being understood, the
indications for treatment may be summed up briefly. If
possible treat the patient in time to avoid the systemic condi-
tion which gives rise to eclampsia. If a convulsion comes on
give chloroform to control it. This done, diminish ner\'0us
sensibility, to reduce the convulsions in frequency and in
violence, by giving hypodermatically fifteen drops of the fluid
extract of veratrium viride, and administer per rectum a
drachm each of chloral hydrate and potassium bromide in
solution.

Hasten next to eliminate the poisons from the blood, by
proceeding as follows : Place two drops of croton oil diluted
with sweet oil on the back of the tongue. The body should
then be enveloped in blankets which have been wrrung out in
hot water, until there is free diaphoresis. In the meantime
the head should be kept cool with an ice cap. Next by hypo-
42

658 FIFTY-FIFTH ANNUAL SESSION

dermaclisis a pint of normal salt solution should be injected
under the integument over the breast ; and by gravity several
quarts of the solution injected into the bowel. As soon as
practical repeated doses of magnesium sulphate should be
administered until there is free catharsis. Venesection is
practiced with good results by some. Again the use of large
doses of morphine, by hypodermic administration, with some
physicians, has given good results. Pilocarpine should never
be used on account of its depressent action, and its tendency to
cause cedema of the lungs.

Having thus briefly mentioned a few features of eclampsia,
I shall now report also briefly some cases I have met with in
my practice :

Case 1. — Married; age, 22 ; nearly seven months advanced;
much swollen in face and extremities; weight, about 105
pounds. Patient inherited weak kidneys, and when first seen
had been swollen about five weeks. When I was called in
consultation the patient had for twenty-four hours been hav-
ing convulsions at intervals of from two to three hours. The
treatment used up to this time consisted of chloroform to
control the convulsions, quarter-grain doses of morphine In-
jected under the skin, and five-drop doses of tincture of
veratrium viride given in the same manner. We discon-
tinued the morphine and pushed the treatment outlined above.
The convulsions did not return, and with the eliminative
treatment kept up the symptoms improved nicely for two
days. On the third day, in spite of the treatment, the symp-
toms grew worse. The family was then consulted and agreed
to an immediate delivery.

With no instruments at hand except obstetrical forceps,
and no help ])esides two negro women, I went to work. By
the digital method I soon had the os dilated to the size of a
dollar. One blade of the forceps was then introduced a few
inches and allowed to remain until labor pains started up, and
was then removed. Tavo hours later the head was engaged
in the superior strait. Further advancement practically

N. C. MEDICAL SOCIETY. 659

ceasing, I applied the forceps, and soon effected the delivery.
This was done while the patient was under chloroform anes-
thesia. She stood the ordeal very well, but suffered some a
few hours later from shock. There was no difficulty in de-
livering the placenta. About twenty-four hours after labor
was concluded, notwithstanding chloral, bromides and epsom
salts were being pushed, together with the normal saline solu-
tion and the hot packs, used as suggested above, there was
another convulsion. This was controlled with chloroform.
After this the patient improved rapidly. Dietetic, hygienic
and medicinal treatment was kept up for two months, when
the urine became free of albumin, the digestion became nor-
mal, and there was no more headache. The patient was then
dismissed, and now, eight months later, is in excellent health.
The baby lived only twelve hours.

Ckise 2. — An umnarried negro; age, 19; weight, 150
pounds ; primipara ; about seven months pregnant. She was,
without warning, seized with a convulsion while at work in
the field. After she was carried to the house she had four
other fits, before I saw her, at intervals of about three hours.
In this instance, for good reasons, I felt justified in termi-
nating pregnancy at once. Treatment was given to control
the convulsions, and the woman was delivered in a few hours
with much more ease than was experienced in case No. 1.
With the exception of a single fit on the eighth day after de-
livery, which was due, I think, to a neglect of the treatment
prescribed, the woman made a rapid and uneventful recovery.
The baby, mixed blooded, and not a very welcome visitor,
died three days after birth.

Case 3. — This case, I am not sure, can be classed as eclamp-
sia, as the convulsive seizures came on twelve months after
confinement. The patient was an unmarried cook, multi-
parje; age, 30; weight, 130 pounds. She gave a history of
convulsions coming on soon after labor and continuing for
ten days. She was attended in confinement by a negro mid-
wife, who assured the patient that the "afterbirth" was de-

660 FIETY-riFTH ANNUAL SESSION

livered. The baby died soon after birth. The fits stopped
coming on, but her abdomen remained large. This she thought
was normal. After twelve months, with the return of the
convulsions, I was called in. Careful examination revealed
that the uterus was distended and that the cervix was boggy.
A retained placenta was suspected. The woman was put
under the influence of chloroform, the cervix dilated one and
one-half inches, and by Crede's method a whole placenta was
expressed. This was in a putrefactive state, but showed that
about one inch of the cord was still intact. Eliminative treat-
ment was adopted, and by the end of the third week the urine,
which at first would solidify on heating, was free from
albumin. There were no more convulsions, and after a
month the woman was back at her work.

N. C. MEDICAL, SOCIETY. 661

PLACEXTA PREVIA— ITS ETIOLOGY Ai^D
TEEATMENT.

BY H. B. HIATT, CLINTON, N. C.

The occurrence of placenta prsevia is due either to an at-
tachment of the ovum to the endometrium of the lower uterine
segment in the vicinity of the internal os, knov^n as primary
placenta prgevia ; or is due to the ovum having become at-
tached, at a point higher up on the uterine wall, growing, in
the course of development, downward until it reaches or en-
croaches upon the internal os, known as secondary placenta
praevia.

^N'oraially the placenta grows an equal distance in all direc-
tions from the insertion of the umbilical cord. The inser-
tion of the cord represents the point of the first vascular sup-
ply to the ovum from the foetal side. This concentric growth
around the cord insertion is due to the fact that the nutritive
and developmental conditions of the ei'dometrium are equally
favorable in all directions from the primary attachment. The
formation of secondary placenta preevia shows that these nu-
tritive and developmental conditions of the endometrium are
lacking above and increase below as the internal os is ap-
proached. These conditions, whatever they may be, that
render the mucosa of the uterine body walls less fertile and
the mucosa of the lower uterine segment more fertile, are the
agents that play the most important etiological role in the
formation of placenta prsevia.

The ideal sites for placental attachment are the middle of
the anterior and posterior walls of the uterine body. These
spots offering the best source of nourishment for the develop-
ing ovum, due to the fact that the mucosa is thickest, richest
in glandular structure, more energetic and particularly for-
tunate as to vascular supply; the union of the four great arte-
rial trunks occurring at this point. It is here that the ovum
is nonnally Implanted ; faulty attachment being due to some

GG2 riFTY-riFTH annual session

error in the conditions which should bring about the more
normal attachment. This error, Stassman thinks, depends^
l^rimarily, upon malnutrition of the normally more fertile
areas. So for an attachment of the ovum to the lower uterine
segment the mucosa of the uterine body must be less adapted
to furnishing the nourishment sufficient to carry the ovum to
full term or the mucosa of the lower uterine segment, better
adapted to furnish the necessary nourishment.

By exhausting and rendering less fertile the normally nu-
tritive soil of the body walls, numerous and rapidly recurring
pregnancies predispose to the formation of placenta pra^via.
The histories of placenta prajvia patients show about 90 per
cent of them to be multiparse, and of these an overwhelming,
majority give a history of endometritis and subinvolution in
previous pregnancies. These two conditions stand out more
prominently than any others as predisposing causes to ab-
normal placental attachments. In themselves they can not
influence the implantation of the ovum, but by bringing about
various vascular and anatomical changes in the endometrium
(and more than likely the muscular element also, for it ia
readily seen that due to the intimate connection of the two
with no interA'ening connective tissue layer to break the con-
tinuity of the advancing infection, that it would soon reach
the muscularis), these changes would have a direct effect
upon the nutritive value of the various regions. By causing
changes in this nutritive value they would thus exert their
influence upon the location of the placenta.

It is probable that during the earlier stages of development
any spot that offers an attachment for the oviun will suffice,
and at this stage the conditions just mentioned would hardly
matter; but the probability of the gestation continuing to
full term diminishes in proportion to the unfavorable condi-
tion of the mucosa upon which it is growing. An ovum im-
planted upon a soil rendered unfavorable by endometritis or
any other condition, will as it grows older and needs more
nourishment arow in the direction from which its nourishment

X. c. :\rKr)iCAT. socikty. 663

is furnished, and thus to the point where the mucosa is rich-
est and most energetic. Endometritis renders the mucosa of
the middle of the anterior and posterior walls of the uterus
less fertile and more unfavorable in all ways as a placental
site. And it is for this reason that it is to be classed as the
most frequent and surest cause of the occurrence of placenta
prsevia.

The pathological picture of endometritis is one of an in-
tense congestion of the uterine mucosa, the adnexia and the
vessels supplying these parts, with a subsequent necrosis and
sloughing of the mucosa and a great infiltration. "^^In en-
dometritis as elsewhere the primary result of the inflamma-
tion is an increase in size (congestion), while the ultimate
effect is cicatricial contraction." (Gilliam.)

The increase in size of the lymphatics and blood vessels and
the clots in the opening of the vessels and the great denuded
placental site offer very favorable opportunity for the infec-
tion to invade the deeper structures, and in this way make
the inflammatory processes more severe and the cicatricial con-
traction still greater. The most susceptible point and the
one showing the most active changes is the recent placental
site. Here the infection is more severe in form, more active,
and the inflammatory changes greater, due to the lessened re-
sistance of this spot and the relatively greater resistance of
the rest of the organ. The inflammation is greatest and the
necrosis and sloughing greatest where the mucosa is most
richly supplied with glands and blood vessels, namely, the
middle of the anterior and posterior walls of the uterus.
From their anatomical characteristics, and being the usual
placental sites, these two points bear the brunt of the process.
The regeneration of the mucosa after the necrosis and slough-
ing subsequent to the infection is slower and more imperfect
than the regeneration following other destructive processes-
such as menstruation and normal uninfected puerperium.
The regenerated mucosa appearing in the place of that lost
is not nearly as well provided to take care of the ovum as

6Q4: FIFTY-FIFTH ANNUAL SESSION

the original mucosa. In the regions of the tubal and cervical
openings the mucosa does not undergo the great changes and
extensive necrosis of endometritis as is experienced by tho
other regions, because tJie mucosa in these regions is not so
highly developed, so rich in glands or so well supplied vascu-
larly. Because of their lessened changes their regeneration
is quicker, better and nearer normal than is the case with
the body mucosa.

!N^ow this being the case and the above facts being con-
sidered, would it not be reasonable and rational to suppose
that these regions having made a complete recovery and carry-
ing an excessive amount of blood to the more severely at-
tacked portions become, because of this greatly increased
blood supply, the seat of an over-regeneration and assume
more the character of the body mucosa and thus supersede the
body mucosa as a more fertile spot for placental attachment.
It is known that frequent attachments of the placenta to
a given site on the endometrium may ultimately so effect, by
vascular and chemical changes, that site as to render it unfit
and to render other parts of the mucosa more favorable for
the attachment of the placenta, and thus act as a cause of
placenta prsevia or some other abnormal attachment.

It is also a well-known fact that a long-continued increased
blood supply results, in healthy tissues, in a hypertrophy,
which is a condition of over-regeneration. Now with this
condition of over-regeneration resulting from the hyperssmia
may it not be the ease, that this fight for life followed by the
prolonged fight in regeneration, and the cicatricial contrac-
tion, leaves the normal site in an exhausted condition, re-
sults in anatomical (vascular) and chemical changes, and so
renders it unfit for supplying the ovum with necessary nour-
ishment to allow the pregnancy to reach full term ?

It does not follow that this abnormal attachment meets the
requirements of the ovum as well as the normal attachment
or furnishes as much nourishment to the given amount of
space. For this is disproven by the i^ize of the previa pla-
cenTa, tlie size being 100 to 200 sq. cm. larger in the

X. C. MEDICAL SOCIETY. 665

praevia placenta, this increase being due to spreading to obtain
more food. To repeat, it does not follow that the mucosa of
the lower uterine segment fulfills as well the conditions neces-
sary to normal growth and development of the ovum as the
other parts of the uterine mucosa do in healthy and normal
attachments. But the point is this : the mucosa of the lower
uterine segment, even in its imperfect condition, furnishes a
better ground for nourishing and developing the ovum than
the endometrium of the body wall that has been exhausted
by its fight for life and rendered anatomically unfit, more
•or less, by the inflammatory and cicatricial changes incident
to the disease.

Treatment.

I will not attempt to discuss in detail the treatment of pla-
centa prsevia, but will only call attention to the more im-
portant points, considered from three (3) standpoints: (Ibt)
Prophylaxis; (2d) Before labor; (3d) During labor.

The prophylaxis of placenta praevia is mainly dependent
upon three things: first, the prevention of endometritis; sec-
ond, the proper attention during the puerperium to insure
complete involution; and third, the prevention, if possible,
of rapidly recurring pregnancies. The prevention of en-
dometritis before and during labor is only insured by perfect
.asepsis. This being next to impossible, we should use every
antiseptic precaution at our command.

After labor as a prevention both of endometritis and sub-
involution of all debris; any pieces of placenta or shreds of
membranes retained should be removed. All lacerations of
the genital tract and other lesions incident to parturition
should receive the proper attention.

Rest in bed with nourishing but light diet with proper
•elimination until complete retraction and contraction of the
uterus has occurred is most important. The danger of allow-
ing a patient with a soft, boggy uterus to sit up and to re-
sume her domestic affairs too early is readily appreciated.
After perfectly normal labor with no infection or abnormal
■complications the danger of subinvolution with various mal-

666 FIFTY-FIFTH ANNUAL SESSION

positions of the uterus resulting is still to be reckoned with
if we do not give the proper attention to the puerperiuin.

The abnormal positions assumed by the uterus incident to
the subinvolutional exert more or less influence upon the
vascular supply, causing it to be lessened in some regions and
increased in others. This disturbance in the vascular supply
will necessarily cause the endometrium to undergo atrophy
changes where lessened and hypertrophy were increased, and
in this way affect the implantation of the future placenta.
The management of labor and the puerperium is a subject
which deserves more consideration than could be given here.
I merely mention the above points to show the importance of
the proper management as a preventive measure of en-
dometritis and subinvolution, and through these of placenta
prsBvia.

The treatment during pregnancy is viewed differently by
the different authorities. Some favor immediate delivery,
others preferring to temporize and allow the pregnancy to go
to full term if possible and then employ the procedures they
deem best. But the majority agree that if placenta previa
is positively diagnosed, pregnancy should be interrupted. In
those cases of suspected placenta praevia with persistent bleed-
ing, dilatation should be done and the true condition of
affairs ascertained; for in these cases premature labor will
supervene any way. And again, a case of persistent hemor-
rhage during pregnancy is usually significant of one of two
conditions, viz : Placenta praevia or premature separation of
a normally implanted placenta. In either case the contents,
must be at once removed if your woman is to be saved. In
removing the contents dilatation should be begun with a
Goodell's or some other like instrument, and completed man-
ually. The most all-around satisfactory method of extrac-
tion is internal pedalic version, one foot being brought down,
and thus allowing the buttocks to act as a tampon. If hem-
orrhage ceases after version is performed expulsion may be
left to nature, but if oozing continues gentle traction upon the
leg should be employed so as to more firmly compress the

N. C. MEDICAL SOCIETY. 66T

placenta with the buttocks. Extraction should not be at-
tempted until the cervix is sufficiently dilated to admit of the
passage of the head or cervical tears will result and cause
more hemorrhage. In those cases where the cervix is so rigid
that manual dilatation can not be employed a tight cervical
and vaginal pack of sterile gauze should be used. This will
check the hemorrhage and will produce sufficient dilatation
after a few hours to permit of the necessary measures for
delivery.

At the time of labor the treatment will depend upon the
amount of dilatation present and the condition of the patient.
If the cervix is sufficiently dilated immediate delivery either
with forceps or by version is indicated. If the patient has
not been weakened by loss of blood, then with a central va-
riety the leg can be brought down by version and let the dila-
tation proceed naturally. With a marginal variety and only
slight hemorrhage the membranes may be ruptured and the
placenta allowed to follow the retracting walls. This will of
course prolong labor somewhat, but we have the head to act
as a check to hemorrhage by pressure and more possibility
of a living child being born than by the rapid dilatation and
Braxton Hick's method of delivering. However, should suffi-
cient hemorrhage occur to rapidly weaken the patient, rapid
dilatation and immediate delivery is indicated.

Csesarean section is strongly advocated by some obstetri-
cians, and their reports show very good results. The ma-
ternal mortality has been lowered, but as yet there has been
but very little if any reduction in the infantile mortality.
The Csesarean operation will do very well for the skilled
operator, surrounded on every side with well-trained assist-
ants, perfect appliances for operating and every facility for
the care of his patients. But for the man who has to rely
more or less on nature to do his nursing, with little or no as-
sistance and very imperfect conditions on every hand, there
is little hope of saving the infant and very grave danger of
losing the mother.

668 FIFTY-riFTH ANNUAL SESSION

EXCISION OF THE COCCYX (COCCYGECTOMY),

BY JOHN E. IRWIN, M.D., CHARLOTTE, N. C.

Coccygodynia is the indication for this operation. This
affection is characterized by severe pain in the coccygeal
plexus and the vicinity of the coccyx. This pain, v^hich oc-
curs almost exclusively in women, is increased by the slightest
movement of the bone, particularly from contraction of the
gluteus maximus, the coccygeus, the ischio-coccygeus, the leva-
tor ani and the sphincter ani muscles. It is often obstinate
and is due to various causes, such as fracture and dislocation
of the coccygeal vertebra, from a fall, kick, forceps delivery,
etc., or inflammatory processes in the bone, its joints or
vicinity. The pain is usually due to inflammation as well as
pressure upon the fifth sacral and coccygeal nerves. In many
cases no special cause can be found, and we have to deal
merely with neuralgia.

Three-fourths of the cases are due to injuries in labor.
There is frequently temporary pain (coccygodynia) in the
coccygeal joint following labor, due to strain of the anterior
ligaments of the bone, but disappearing some weeks after.

Men are almost immune because they do not bear children,
and because the bone is better protected in them than in wo-
men from external violence by the higher situation and the
closer approximation of the tuberosities of the ischia, and
because there are not the same development and mobility of
the muscles of the pelvic floor and gluteal region.

The second coccygeal joint is more often affected than the
first. The patient complains usually of pain ''in the very
end of the bone." With every step, every effort to sit down
or rise, with every movement of the sphincter ani, the bone
is pulled upon and moved.

Coccygodynia must be distinguished from vaginismus, hem-
orrhoids and anal fissure by physical examination.

X. C. MEDICAL SOCIETY. 669

Dr. J. C. Xott, of Mobile, Ala., described an operation in
the Ne^v Orleans Medical and Surgical Journal, May, 1844,
by T\'liieh the last two coccygeal bones were removed for what
he called "neuralgia of the coccyx." Fifteen years later, in
IS 59, Sir James Y. Simpson described a disease of the
coccyx, which he said could nowhere be found mentioned in
books, and for which he proposed the name "coccyqodynia-"
He advocated as treatment subcutaneous section of all the
tendinous and muscular attachments of the coccyx. Good re-
sults have been obtained by subcutaneous division of the
muscles and ligaments that are attached to the coccyx, par-
ticularly the gluteus maximus and sphincter ani. Knowing
that the surest method of bringing about a permanent cure
consists in excision of the bone, this method was adopted in
the following case :

Miss B., age nineteen, February 12, 1906, fell astride the
sharp edge of a step, the coccyx receiving the force of the
fall. Since that time she has been practically an invalid,
unable to sit up or walk without pain in and about the bone,
and consequently has spent the greater part of the time since
the receipt of the injury (over two years) in bed. Thus her
college course was intercepted, and she was incapacitated for
work. Her family history is good and she had never been
sick or confined to bed.

Learning that general and local treatment had been faith-
fully tried without benefit, and finding by physical examina-
tion an extremely tender and painful condition of the parts,
which had existed all these months, I decided that excision
of the coccyx was indicated and imperative.

After thorough general and local preparation the patient
was anesthetized and placed in an exaggerated left latero-
prone position. An incision was made from the tip of the
coccyx upward, and the entire length of the bone exposed.
The tip was freed by severing its attachments with the scalpel.
It was then grasped by bone-holding forceps and pulled out-
ward, and the lateral structures which were thus put upon

670 FIFTY-FIFTH ANNUAL SESSION

the stretch were divided up to the sacro-coceygeal articula-
tion, which was then divided with the scalpel. It is always
best to disarticulate the joint and not to cut away the coccyx
with bone forceps, as the end of the sacrum may be injured
and necrosis result. The only artery of importance that re-
quired a ligature was the median sacral. The wound was
closed with silk-worm gut sutures, the introduction of which
w^as greatly facilitated by having an assistant place his index
finger into the rectum and push up the bottom of the wound,
which is always very deep and difficult to close unless it is
made shallow in this way. A compress of gauze was placed
over the incision and held securely in place by a T bandage.
The first four days the bladder was emptied every eight hours
with a catheter in order to keep the wound clean and prevent
infection. For the same reason the bowels were not allowed
to move until the fourth day. The wound w^as washed daily
with a solution of corrosive sublimate 1-1000 and a clean
-compress and T bandage applied. Only one hypodermic of
morphia (one-eighth grain) was given a few hours after the
operation for restlessness and pain.

In ten days the patient was walking around in the hos-
pital, and three weeks later left for her home, a well and ex-
ceedingly grateful patient. The result of the operation is
most gratifying in the symptomatic relief afforded. Have
Tieard from her twice since leaving, and she says that she
hasn't felt the pain at all since the operation.

This operation is tedious and more diflScult than might be
supposed. The dangers attending it are infection, wounding
the posterior plexus of veins or rectum. There are three
methods of treating the wound : closure, as in the case re-
ported ; drainage with strands of silk-worm gut, and the open
method. In my opinion the drainage method is preferable.
The open method is not a good one, as the healing process is
exceedingly slow and troublesome, owing to the great depth
of the wound and the frequent occurrence of infection taking
place from the rectum.

JSr. C. MEDICAL SOCIETY. 671

My reason for presenting this subject and case to the So-
ciety is, it is rather rare and seldom if ever discussed ; to call
your attention to the three methods of operating ; to the com-
plete relief following the operation ; and to call your attention
to the fact that the disease was first discussed and the opera-
tion for its relief was first suggested by Dr. J^Tott, a Southern
physician and surgeon; and to help encourage the presenta-
tion of short and practical papers to the Society.

672 FIFTY-FIFTH ANNUAL SESSION

HYSTERECTOMY, WITH REPORT OF A CASE.

BY R. O. DEES, M.D., GREENSBORO, N. C.

Tlie subject of hysterectomy is one of significant impor-
tance and one with which the surgeon will have to meet from
time to time.

The question will often present itself, shall we remove the
uterus at the time of removal of both tubes and ovaries, and
if we fail to remove the uterus do we fail to remove all foci
of infection ?

There are, of course, in this procedure many arguments
pro and con to be presented, but in many a radical operation
it is the only conservative course to pursue.

During the last decade we have learned more of the gross
and microscopical pathology and physiology of the pelvic
organs, and since the introduction into surgery of aseptic
measures, hemostatic forceps, aseptic ligatures, absorbable
and nonabsorbable suture material and the seamless rubber
glove, etc., we are enabled to enter this field of surgery and
alleviate pain and suffering of patients at a comparative mini-
mum risk and danger to them. We are frequently confronted
with the question in cases requiring a salpingo-oophorectomy
whether or not to do a hysterectomy. When Ave consider the
fact^that the greater percentage of operations upon the tubes
and ovaries are for pyo-salpynx, and before this condition
occurs that the infection has traveled through the uterine
cavity first and caused an endometritis, and in a large number
an existing metritis, then are we justified in leaving behind
this diseased organ and only give our patient a temporary
relief by doing the salpingo-oophorectomy, as an operation of
this kind will, in all probability, give only a temporary relief.

The internal organs of generation, viz, uterus, tubes and
ovaries, possess a joint function, and any one of them is de-
pendent upon the other. The uterus, deprived of its adnexa,
becomes a useless and nonfunctioning organ, and in any con-

N. C. MEDICAL SOCIETY. 673

dition requiring a salpiugo-oophorectomy and there is a ques-
tion of doubt in the mind of the operator as to the healthy
state of the uterus, is it not a justice we owe our patient and
conservative surgery to remove the organ ? The tendency is
towards conseiwative surgery, but not beyond a point to fail to
alleviate a pathological condition. This same conservatism
has been used in supposed innocent fibro-myomata in the ex-
pectation that at the time of menopause the patient would
be restored to health and happiness, and instead to find that
she is a greater invalid and a possibility of the fibro-myomata
becoming necrotic or septic, and places her life in the gravest
peril, and after all may die in spite of surgical intervention.
There are a few well-selected cases in married women, or those
contemplating marriage, where a myomectomy or an enuclea-
tion of a subperitoneal fibro-myomata would be a justifiable
procedure, but, indeed, these cases are few and far apart. In
this connection it has been stated by Bland Sutton that during
this procreative period of a w^oman's life she is tw^enty times
more likely to grow more fibroids than to conceive success-
fully. A complete removal of the uterus is not at all neces-
sary in the class of cases referred to, but the less radical ope-
ration of supravaginal hysterectomy being quite sufiicient. By
an amputation of the uterus at the internal os the support of
the pelvic floor is not diminished. The vesico-uterine attach-
ment is undisturbed, and there is no tendency to prolapse of
either the bladder or rectum unless there has been some pre-
vious existing weakness of the pelvic floor. In a great many
of these cases we will find a displaced and often an enlarged
uterus, a condition which can only be successfully relieved by
high amputation of the organ. Frequently the pelvic in-
flammation has reached such a point and adhesions so numer-
ous, and everything so matted together, that the less radical
hysterectomy is the only course left to us to pursue.

Influexce ox MEISrSTRUATIOlSr.

An artificial menopause is inevitable after the removal of
the ovaries. We know that ovulation and menstruation are
43

674 FIFTY-FIFTH ANNUAL, SESSION

associated and more or less dependent upon each other. How-
ever an individual may menstruate a few months after a
salpingo-oophorectomy, this temporary menstruation being
the result of habit or what not while the individual adapts
herself to the changes made as the result of the operation.
Experiments upon dogs shoAv that after the removal of the
ovaries of a pregnant dog she will abort, and to remove
the ovaries of a second pregnant dog, at the same period of
advancement, and inject from time to time an emulsion made
from the ovaries of a dog that she will go on to full term.
This experiment demonstrates the fact of an internal secretion
of the ovary which plays an important role in the physical
economy. This experiment and other like experiments dem-
onstrates the fact that it is useless to leave behind probably
an enlarged uterus and one having a malposition, or possibly
a small tumor, or one having an inflammation of its mucous
or muscular coats, and many other pathological conditions too
numerous to mention, in the expectation that at the time of
menopause these conditions will correct themselves and clear
up ; and, on the contrary, find that all the symptoms are ex-
aggerated and the patient is a greater sufferer and invalid
than prior to the time of the climacteric.

Mortality.

The mortality rate is no higher in an hystero-salpingo-
oophorectomy than in the less radical operation as a simple
oophorectomy, unless the patient is already shocked; then
to prolong the operation by removal of the uterus, as such
operation would necessitate some time, might result in a fatal
termination by producing more shock ; but when shock is not
an existing complication a removal of the uterus and its ap-
pendages by supravaginal amputation will remove all foci of
infection, and we expect, and will in all probability get, a per-
fect result. The case which we now report is one bearing
along the same lines as we have tried to outline.

Case. — E. B., age thirty ; housewife.

When called to see patient January 26, 1908, found her
eomplaining of a lump in abdomen. Pulse was rapid and

N. C. MEDICAL SOCItTY. 675

M'irv. Some elevation of temperature, and the entire ab-
dominal region hyperesthetie. Palpation revealed a tumor
extending to the umbilicus. A superficial examination only
was made on account of the pain produced thereby, but the
condition was plainly one of a true surgical nature and ope-
ration was advised, to which patient promptly consented,
and was admitted to St. Leo's Hospital January 26, 1908.
She was prepared for operation over night in the usual
routine manner. Two hours before operation, however, she
was given hypodermically morphia, grains one-ffeurth;
scopolamin, grains 150. This repeated one-half an hour be-
fore operation was begun, complete anesthesia being com-
pleted wath ether. On palpation this large fibro-myoma was
easily made out extending to the umbilicus, and numerous
smaller fibro-myomse were also easily palpable. On vaginal
examination the pelvis showed marked inflammatory thick-
ening and a mass on either side, more marked on the right
side. On abdominal section some sero-sanguinous fluid was
noticed. The pelvis was one mass of adhesions, extending
from tumor and uterus to intestines and bladder and to the
pelvic walls. Examination of the tubes and ovaries showed
the former to be very much infiltrated and presenting the
appearance of pus formation, and the latter to be very much
congested and very much cystic. These organs were diseased
to such extent and so involved in adhesions that the leaving
behind of any part of them would have been the leaving be-
hind of that great focus of infection to give trouble in the
future, and the only conservative course to pursue was to
remove them en masse. This was done by a supravaginal
hysterectomy. On examination of the appendix it was found
to be about twenty cm. in length and very much congested
and tied down to the csecum by bands of adhesion. The dis-
tal end was bulbous and presented the appearance of having
undergone numerous catarrhal inflammatory attacks. This,
of course, was removed. The patient by this time was greatly
shocked, due to the extent and time of the operation. She
was infused with normal salt solution, to which a small

676 FIFTY-IIFTH ANNUAL SESSION

quantity of adrenalin chloride had been added, surrounded
with hot water bottles and given stimulants of strychnine
and whiskey, to which she promptly reacted. Nausea was
a distressing symptom and lasted five or six hours, after
which time it cleared up and patient went on to an uninter-
rupted and uneventful recovery, and has continued well to
date and is able to attend to her household duties.
Examination of the Specimen.

A section of the specimen after removal showed that there
was a rather extensive calcareous degeneration.

The above case as reported in detail does not show any
special features, but we have tried to make plain that in
some of these cases that attempts at trying to be conservative
and leaving behind dissected portions of an ovary, or what
not, proves fruitless and sometimes fatal. If not the latter,
our patient will continue to be an invalid and can not see
where she has been benefited by an operation, and when they
will not consent to a second operation to let us complete our
job we can not blame them. Therefore, if there is a question
of doubt in the mind of the operator as to the healthy con-
dition of a tube or ovary, or whether or not a small fibro-
myoma will not at some time become septic or necrotic, the
conservative course, naturally, would seem to be to remove
the diseased ovary, tube or uterus, or all, as the case requires,
and we will be doing justice to ourselves and patient, and
may in the greater number of cases expect a quick recovery
and a permanent result.

Urinalysis.

Chemical. Dark amber color; heavy whitish sediment;
reaction neutral ; odor characteristic ; sugar negative ; albumin
in quantities; specific gravity 1040.

MicKOScopicAL Examination.

Pus in abundance; some few red corpuscles; a few hya-
line and granular casts; debris in quantities.

The above analysis was made from a catheterized specimen.
Unfortunately a quantitative albumin test was not made.

N. C. MEDICAL SOCIETY. 677

DIAGNOSIS A^B TREATMENT OF ECTOPIC GES-
TATION FROM THE STANDPOINT OF A COUN-
TRY PHYSICIAN, WITH REPORT OF CASE.

BY G. F. DUNCAN, M.D., HIGH POINT, N. C.

Physicians recognized and treated, in a crude manner,
extra-uterine pregnancy many years ago. With the kind as-
sistance of nature ordinary treatment cured some of these
cases.

In studying this subject it at once becomes apparent that
a great burden of responsibility is thrust upon any physician
who must meet and grapple with this anomaly of pregnancy,
and more especially the country physician who. at best, treats
his surgical cases at a great disadvantage.

In a little more than twenty-five years surgery has blazed
the way to success in the treatment of these multiplex cases,
so that to-day we are expected to do our duty. Keeping in
view the object as set forth in the text, I shall for purpose of
diagnosis consider briefly, first, tubal pregnancy before rup-
ture or abortion of the foetus.

Diagnosis in this form is difiicult. In many cases physi-
cians are not consulted. If rupture does not occur early the
unmistakable symptoms may be readily observed. A careful
and painstaking history of the case is peculiarly important.
Patients with a histoiy of salpingitis, neoplasms and adhe-
sions in pelvis, who have not borne children for years, are
more prone to this accident. Patient generally gives a history
of suspected pregnancy but feels "diiferent" A synopsis of
the diagnostic symptoms are given as follows: History of
cessation of menstruation with recurrence in an irregular,
slight, or may be profuse manner from ten days to a month
or more after missing, the blood differing in quantity and
color; in other words, an atypical menstruation. Unusual
pains, rather severe and of a colicy nature, localized to one
side, in the lower abdomen. Some of the objective and sub-

678 FIFTY-FIFTH ANNUAL SESSION

jective signs of pregnancy are present. Physical examina-
tion reveals a distended tube, or tender mass, with uterus to
opposite side.

By comparison we find that all these symptoms are not
present in any associated trouble. The history will exclude
salpingitis, tumors, appendicitis and intra-uterine, gestation.
The physician should educate himself in the art of making an
accurate bimanual examination and should use the greatest
care, as rupture may be induced. Abortion and threatened
abortion has been mistaken for this form, and curetting has
been done many times under this delusion.

Irregular symptoms of abortion should cause suspicion of
ectopic pregnancy, and no case should be treated as an abor-
tion until after a careful bimanual examination has been
made. Expulsion of decidua is not a practical means of
diagnosis.

In the three varieties of tubal pregnancy, ampullar, isthmic
and interstitial, rupture may occur into the abdominal cavity
or the folds of the broad ligament. In the interstitial form
the ovum may be forced to pass into the uterus and continue
as a normal pregnancy. I have had two such cases, which
was proven by subsequent history, in my practice of ten
years. The fact that nature sometimes takes care of the in-
terstitial variety should not cause us to be less aggressive in
our general management IsTo attempt to differentiate tubal
rupture and abortion will be made in this paper, as the
symptoms and treatment are largely the same.

At the time of rupture or, as some one has said, in the
"tragic stage," the diagnosis is not so difficult. Added to the
foregoing symptoms, before rupture, are classical and I might
say positive signs. Any woman who has a history of regu-
lar menstruation, missing four to twelve weeks, with all or
part of the objective and subjective signs of pregnancy, who
is suddenly seized with intense pains in either iliac region,
which is acute, tearing, excruciating; becoming faint, dizzy,
nauseated and pale (acute ansemia) from the severe shock of

N. C. MEDICAL, SOCIETY. 679

interual hemorrhage, which is out of all proportion in com-
parison ; tender and sensitive over lower part of abdomen,
generally unable to sit up, and when upon examination a
boggy mass is found at one side and posterior to the uterus,
and a slight bloody, shreddy discharge occurs, you have a
group of symptoms found in no other trouble.

In this condition pulse may be from 120 to 180, and a
temperature subnormal. A careful history will differentiate
intra-uterine pregnancy, retroverted gravid uterus, pelvic ab-
scess and abortion. In my experience practically all cases
of ectopic gestation have occurred in women who have history
of salpingitis, or catarrhal trouble of tubes or adjacent vis-
cera, and as this is responsible largely for sterility, hence
history of several years sterility prior to this trouble.

Intra-uterine and extra-uterine pregnancy may occur at or
near the same time. If patient survives shock of rupture
or abortion further symptoms depend on condition of foetus,
as to whether it is living or dead. The first hemorrhage or
rupture as a rule is responsible for death of foetus. In rare
cases, however, the foetus may continue to develop in the
peritoneal cavity, provided its membranes are not torn and
the placenta is intact. In cases seen after death of foetus the
history will enable us to make diagnosis. Some cases of
sepsis and inflammation following a supposed abortion may
be due to an ectopic.

After formation of hematocele absorption or suppuration
may occur. Should the foetus survive gestation may continue
forming abdominal pregnancy, with symptoms and signs
much like the normal form ; menstruation is usually present.
Movements of foetus and foetal heart sounds are easily recog-
nized, as the gestation sack is near the surface. Loss of
symmetry in shape of abdomen is characteristic. The uterus
is enlarged to five or six inches in length. The further diag-
nosis and treatment of advanced extra-uterine gestation will
be considered in report of case.

That ovarian pregnancy does occur as a primary condition

680 FIFTY-FIFTH ANNUAL SESSION

is now admitted, but does not merit a separate discussion
here.

Treabnent. — Here our duty is clear. Operate nnder any
and all circnmstanees. All children die, and 75 per cent of
the mothers, if neglected. The mortality after operation is
low. The life of the child should not be considered, our obli-
gation being to the mother. If operation should reveal fact
of error in diagnosis the associated trouble usually requires
the abdominal section.

The operation in cases before rupture or abortion is simple.
Technic is the usual one for removal of suppurating tube.
Great care should be used lest the impregnated tube should
be ruptured. The ovary should not be removed unless dis-
eased.

At time of rupture operate without delay. Do not wait
for reaction from shock. Stimulate by injecting one-half
liter of normal salt solution into cellular tissue under the
breast.

Complete in detail preparations for operation, in order
that it may be done more rapidly. Avoid rough manipulation
in sterilizing abdomen. Use smallest possible amount of
anesthetic. Make long incision, twelve to sixteen cm., in
order to avoid delay.

Dr. Kelly enumerates the general principles of the radical
operation as follows : Separation of adhesions enveloping
sack, removal of blood, foetus, membranes, placenta and sack.
Checking of all hemorrhage. If hemorrhage is active con-
trol the uterine and ovarian arteries by clamp. Apply neces-
sary ligatures to control hemorrhage. The entire tube is
easily removed by salpingoctomy. If ovary is diseased or
adherent it should be removed. Complete toilet of peritoneum
and close the abdomen by the quickest safe method. In the
country I believe it safest to use gauze drainage in every case.

The operation differs widely, according to complications
found. Personally I do not favor the vaginal operation. The
after-treatment is the same as in other grave laparotomies.

X. C. MEDICAL SOCIETY. 681

Absolute quiet should be enjoined, stimulants given, heat
applied and a normal salt solution used every four hours as
needed.

In cases seen subsequent to rupture or abortion the sur-
geon can determine best time to operate. It is not safe to
wait for nature to relieve the patient.

A case illustrating the difficulties experienced in diagnosis
and treatment of ectopic gestation in the country is that of
M. J., operated on by the writer at Sparta, N. C, on May
26, 1908.

Patient was a negress, thirty-two years old ; four children ;
youngest four years old. With the exception of some tender-
ness in region of ovaries and painful menstruation previous
Jiistory was good.

Patient missed on April. 1907, menstruating profusely
during latter half of May, experiencing some pain like slight
colic in umbilical and epigastric regions and extending up-
ward.

A physician was called, but no diagnosis made. Patient
remained in bed two weeks, and was weak for some time;
gradually regaining her strength, enabling her to do light
housework.

Two months later, or some time after the middle of July,
she menstruated again and thereafter regularly to date of
operation.

An enlargement of the abdomen was discovered some time
in September, which gradually increased in size until about
January, after which it remained about the same, perhaps
•decreasing some in size, until May, 1908.

She vomited occasionally during the summer and fall, and
thought herself to be pregnant, but felt very different to her
previous pregnancies ; complained of much pain and dis-
t'omfort during August and September in stomach ; finally
taking her bed aliout the first of i^ovember.

During first of January she was taken with violent pains,
located as l>efore mentioned, which lasted over a week. . A

6S2 PIFTY-riFTH ANNUAL SESSION

doctor was called in and digital examination was made. Pa-
tient was told that she was pregnant but could not be de-
livered until labor pains became stronger. She remained
in bed more or less constantly till May; was examined by
two other physicians who pronounced her pregnant, but did
not report anything unusual. No movements of fcetus were
experienced except, perhaps, slight during the agonizing
pains. Patient was seen in consultation May 23, 1908. She
was very much emaciated, anssmic, nervous and prostrated.

Inspection revealed a distended abdomen. By palpation
I found a large tumor mass, which was moderately tender.
In left hypochondriac region, under margin of ribs, could
be detected an object like a child's head. The resisting mass
extended transversely across abdomen to right hypochon-
driac and lumbar regions. In umbilical region the mass
felt firm and hard. There was a very perceptible sulcus be-
tween the umbilicus and pubes, showing that the object was
high in the abdomen.

Internal examination revealed a normal uterus, the cervix
being unchanged. Bimanual examination determined the
fact that the tumor mass was entirely separate from and some
distance above the womb. A sound was introduced the usual
distance into the uterus, the findings being normal. Diag-
nosis of abdominal pregnancy with a dead foetus was made
and immediate operation was advised.

The physicians present, Drs. Doughton, Choate and
Smith concurred in the diagnosis.

Before discussing the operation I want to call attention
to the fact that my instruments were in High Point and it
was twenty-five miles to the nearest railroad point, in a part
of the country where abdominal sections have not been done,
patients usually going away to a hospital.

In taking inventory of instruments which could be col-
lected I found that I had five small hemostatic forceps, one
grooved director, one small pair of curved scissors, one pair
of bullet forceps, knife, needles, needle-holder, silk and cat-

If. C. MEDICAL SOCIETY. 683

gut. The abscence of some needed instnunents was very
conspicuous, specially abdominal retractors; however this
trouble was easily overcome as 1 found at a general store two
twelve-inch spoons, selling price five cents. The handles of
these were bent down in the proper curve, making two splen-
did abdominal retractors, which were added to our equip-
ment.

!N^o gauze could be found. I purchased some cheap do-
mestic and prepared my sponges and abdominal pads and
dressings from that.

The dining room of a residence was used for operating
room. We had no sterilizer, but substituted pots, pans and
boilers, which we kept busy for nearly half a day, sterilizing
sponges, dressings and instruments, which were wrapped
in tow^els, and were not removed until operation was begun;
sponges, pads and dressings of course being wet. Patient
was prepared in the usual way. Plenty of reliable sterile
water was on hand. One of Abbott's hyoscine, morphine
and cactin tablets was given, and a small amount of chloro-
form used. The incision, after being extended, was about
seven inches in length, exposing a sack which was intimately
adhered to all surrounding structures. My fingers sepa-
rated the adhesions from the abdominal walls, which was
done w^ith very little trouble.

, The child was found to be in a transverse position, with
its back to the abdominal wall, the head located as before
described. I was soon enabled by the use of fingers and
handle of knife to separate adhered intestines from Ae child's
legs, which were brought up through the wound and held by
an assistant, while further adhesions of abdominal viscera
were separated and child was delivered.

Xo bleeding points were ligated ; patient losing only a
small amount of blood.

A very large placenta was found above the womb, which
was adhered by strong adhesive bands to the bowels, about
the left ovary, and to the womb through its ligaments; it

684 FIFTY-FIFTH ANNUAL SESSION

was soon separated and removed. Some ligatures were ap-
plied in separating the adhesions.

The left ovary was atrophied and left tube inflamed, but
there was no evidence of rupture about the tube ; both ovary
and tube were removed. Right tube was also removed, it
being diseased. A cyst was found and punctured in right
ovary.

Abdomen was flushed out with sterile normal salt solu-
tion and closed in the usual manner, with drainage; my
special brand of gauze being used.

The placenta was firm, apparently of a fibrous develop-
ment. The child weighed eight pounds, and had a mummi-
fied appearance. According to indications it had gone to
full term and had probably died in January, at the time
the patient had the severe attack of pain, which was a spurious
labor.

This would complete the history and make April, 1907,
the beginning of pregTiancy.

Patient was under the anesthetic something over an hour,
and rallied without any great amount of shock.

Subsequent History. — Patient made an uneventful recov-
ery ; temperature being normal the whole time.

The important points gleaned are as follows: Patient
never complained of pain in pelvis or low down in side, the
pain being at all times in umbilical and epigastric regions,
extending upward.

There were no adhesions to either tube and no evidence of
rupture in either tube.

The ovary was connected by slight bands of adhesions, the
case probably having been primarily an ovarian pregnancy,
w^hich condition is considered rare.

Xo history of typical pain and shock of rupture was
given. The omentum was absent. The position of the child
was very high.

Four doctors had made an examination during the course
of the trouble without any expressed suspicion of ectopic
gestation.

N. C. MEDICAL SOCIETY. 685

Althougli greatly handicapped in doing the operation, the
patient made a good recovery, without the slightest evidence
of infection, showing that aseptic surgery can be done under
crude circumstances.

I do not believe that a country doctor should hesitate to
operate on any and all of these cases on account of location,
small equipment or fear of sepsis, provided that proper care
is given in making preparation. I would emphasize the fact
that cases of ectopic gestation are abundant and doctors
should form a habit of thinking of their possibility, which
will cause many more diagnoses to occur, and incidentally
many more lives to be saved.

The operation in advanced extra-uterine pregnancy, where
the child is alive, is more difficult on account of danger inci-
dent to hemorrhage.

The best plan after removing the foetus is to tie the cord
as short as possible, leaving the placenta to be discharged
piecemeal at a later date. Gauze drain should be packed
over its site.

In conclusion I want to say that my spoon retractors are
prized very highly and are carefully preserved in my instru-
ment cabinet.

686 FIFTY-FIFTH ANNUAL SESSION

MATERNAL NURSING.

BY w. w. Mckenzie, m d., Salisbury, n. c.

Moralists and obstetricians agree in urging the impor-
tance of the mother nursing her infant. As a rule she thus
best secures her own and its health; she obeys nature's law
and designs; promotes the closest mutual attachment, and
has an important influence in fashioning the first mental
and moral development of her offspring.

The prevalence of wet nursing has been said to be the proof
of a people's decline. Many writers on this subject state
that the ability of the mother, particularly among the well-
to-do, to fulfill this most important function is surely de-
creasing. This may have been a true statement a decade
ago; at the present time, however, I am sure it is erroneous.
In my own medical practice I have seen a change for the
better, particularly during the past six years. The young
mother of to-day is better able to nurse her offspring than
was her sister five or ten years ago. I attribute this to the
fact that the youth of the present day are more vigorous,
more nearly normal individuals than were those of a decade
ago. The change which enables more mothers successfully
to nurse their infants is due to two causes: more vigorous
fathers and mothers and more vigorous offspring. Follow-
ing this line of reasoning the more normal the mother the
better able is she to perform this normal function. That this
is true is due to the fact that growing girls and young wo-
men are leading more hygienic lives than formerly. The
making of golf, bicycle and horseback riding, automobiling
and boating popular and fashionable ; in short, the taking
of girls and young women out of doors and keeping them
there a considerable portion of the day has worked a mar-
velous change for the better, both physically and mentally.

A neurotic mother makes the poorest possible milk-
producer. Proportionate to the population there are fewer

iSr. C. MEDICAL SOCIETY. 687

neurasthenics among young women to-day than there were
ten years ago, and I think there will be still fewer ten years
hence. It is a fortunate thing for the future of the human
race that the young woman has transferred her allegiance
from the crochet and embroidery needle to the golf club and
the like. It may be said that our argument holds only with
the wealthy or the well-to-do.

Imitation is one of the strongest characteristics of the
human race, and this tendency in America to outdoor hy-
gienic living pervades all classes.

Food is better prepared and better selected, owing to in-
creased knowledge on the part of the people as to what con-
stitutes proper nutrition. The food and care of the growing
girl have most intimate bearing upon her future life, and if
she is to be called upon to perform the most important func-
tion of womanhood, she surely has the right to demand that
she receive during her girlhood proper preparation, which
heretofore has too often been denied her.

Parents, no matter what their stations in life, are glad to
do what is for the best interests of their children when it is
made clear to them. It is our duty to take parents into our
confidence and explain to them the reasons for the line of
action advised. When they are taught the reason for such
procedure they are far more apt to follow them.

One of the chief requirements of a nursing woman being
that she shall be mentally normal.

There are few conditions in which we are called to act so
variable and so uncertain as in the production of breast milk.
The most successful nursing age is between the twentieth and
thirty-fifth year. I have, however, seen it successfully car-
ried on in a girl of fourteen years. Some mothers will be
able to carry on the nursing for only two months; others
three, five, seven and nine months. It is extremely rare for
the breast milk to be sufficient for a child after the ninth
month.

The followins: can be laid do^\ai as nursina: axioms : A diet

688 FIFTY-FIFTH ANNUAL SESSION

similar to what the mothers were accustomed to before the
advent of motherhood should be taken. There should be from
three to four hours spent daily in the open air, with exercise
which does not fatigue. One bowel evacuation daily. There
should be at least eight hours sleep out of every twenty-four.

There should be absolute regularity in nursing. There
should be no worry and no excitement The mother should
be temperate in all things.

Signs of Successful Nnrsing. — The child shows a gain of
not less than four ounces weekly. This is regarded as the
minimum weekly gain which may safely be allowed. Where
a nursing baby remains stationary in weight or makes a gain
of but two or three ounces a week it means that something
is wrong ; and it will usually, but not invariably, be found in
the milk supply. When a baby is nursed at proper intervals
and the supply of milk is ample and of good quality, it is
satisfied at the completion of the nursing. If it is under three
months of age he falls asleep after ten or twenty minutes
at the breast. When the nursing period again approaches
he becomes restless and unhappy, crying lustily if the nursing
is delayed. When the breast is offered he takes it greedily.
The stools are yellow and number from two to three daily.
The weekly gain in weight under such conditions is usually
from six to eight ounces.

Sign of Unsuccessful Nursing. — When supply of milk is
scanty the child remains long at the breast and cries when
he is removed. He shows signs of hunger before nursing hour
arrives.

A cause of failure in breast feeding and probably a most
frequent cause is a scanty milk supply. The chief nutritional
elements in mothers' milk are fat, 3 to 4 per cent; sugar, 7
per cent ; proteids, 1 to 1.5 per cent. Failures may be due
to a marked disproportion of these elements which may
cause sufficient indigestion and resulting loss in weight to
necessitate a discontinuance of nursing. Then there may
be a high fat from 5 to 6 per cent, or very low fat, from

X. C. MEDICAL SOCIETY. 689

1 to 1.5. In the high fat cases there will usually be diar-
rhoea with green, watery stools. Child strains a great deal
and there are green stains on many of the napkins, also re-
gurgitation or vomiting of some material. The fat globerler
may be readily made out if the vomited material is placed
under a low-power microscope.

Low fat means deficient nutrition and may cause consti-
pation. Sugar is rarely a cause of trouble in nursing a baby.
It seldom varies, ranging from 5 to 7 per cent in the great
majority of breast milk.

Young children, further, have a marked toleration for it.
The proteids of mothers' milk is the most frequent cause of
nursing difficulty. Like the fat, it may be so decreased that
nutritional disorders may be induced in the patient, or it may
be very much increased, the latter being usually the cause
of colic or constipation in otherwise healthy nursing infants.
In such infants curds may be found in the stools, the pas-
sage of which is always accompanied by a great deal of gas.
The milk may contain the normal percentage of fat, sugar
and proteids, but be scanty in amount. Instead of the four
or five ounces to which the child is entitled, he may get but
one or two ounces. Whether or not the quantity is sufficient,
can be determined by weighing the baby before and after
each nursing for twenty-four hours. One ounce of breast
milk weighs practically one ounce avoirdupois. The quality
or strength is determined by an examination of the milk
itself. Before nursing the child is put on the scales w^ithout
undressing, and the weight noted. He is allowed to nurse
fifteen minutes. He is then removed from the breast and
weighed. A child under one week old should gain 1 to 1 1-2
ounces. At three Aveeks of age, 1 1-2 to 2 ounces; four to
eight weeks, 2 to 3 ounces; eight to sixteen weeks, 3 to 4
ounces ; sixteen to twenty-four weeks, 4 to 6 ounces ; six to
nine months of age, 6 to 8 ounces, and nine to twelve months,
8 to 9 ounces. Stationary weight or loss in weight with a
dissatisfied child usually means defect in quantity, "which is
44

690 FIFTY-FIFTH ANNUAL SESSION

readily proved by the weighing. To be fed at the breast may
also cause the child to suffer from an excess of good milk,
in which event there will be vomiting or regurgitations, usu-
ally associated with colic. When this overfeeding continues
dilatation of the stomach develops, vomiting becomes habitual,
the child loses in weight, and the breast milk is said not to
agree, and often, unfortunately, the baby is weaned. This
has been the outcome in scores of cases. When there is
habitual vomiting and colic in nursing baby two things are
to be done: the baby must be weighed before and after
nursing and the milk must be examined.

When it is found that the breast milk is too strong or too
Aveak, or when the normal ratio of fat, sugar and proteid are
not maintained, it may be possible to increase either the fat
or proteids when desirable. The heavy milk will usually be
found in mothers who are robust, who eat heartily and who
take but little exercise. In such a mother the persisting of
a plain diet, allowing red meat but once a day, discontinuing
the malt liquor or wine, and directing that she walk a mile
or two a day, will frequently bring the milk to digestible pro-
portion. However in some cases they will not be successful,
and the colic, constipation and vomiting continues, even
though the quantity obtained at each nursing is within normal
limits.

In some mothers it will be impossible to change the mode
of living except, perhaps, to the discontinuance of alcohol.
When such conditions prevail the mother's milk may be modi-
fied by giving from one-half to one ounce of boiled water or
plain barley water before each nursing. One teaspoonful of
lime water added to one ounce of water before nursing has
made the breast milk agree when otherwise it would have
been impossible.

When the milk is deficient both in fat and proteids a diet
composed largely of red meat, poultry, fish, rye bread, or
whole wheat bread, oat meal, corn meal, with two or three
pints of milk daily, will often be followed by an increase of

N. C. MEDICAL, SOCIETY. 691

both fat and proteids. The use of alcohol in moderate
amounts, in the form of malt liquor or wine, will usually in-
crease the fat. Disappointments in improving the quantity
-or quality of breast milk, however, are frequent. Very few
if any mothers are able to successfully nurse their infants
after the twelfth month.

Maternal condition under which nursing is forbidden. —
When the mother has tuberculosis in any of its various forms
or manifestations, whether it involves the glands, the joints,
or the lungs, breast feeding is to be forbidden. In epilepsy
and syphilis nursing is forbidden. In nephritis and malig-
nant diseases of any nature, and in chorea nursing should be
discontinued.

Women who are rapidly losing weight should not be al-
lowed to continue nursing their infants. In case of serious
illness of any nature, such as typhoid fever, pneumonia or
diphtheria, and upon the advent of pregnancy, nursing should
be stopped.

692 FIFTY-FIFTH ANNUAL SESSION

AN ARTIFICIAL FOOD SUITABLE FOR YOUNG-
INFANTS.

BX CHARLES KOBEKSON, M.D., GBEENSBOKO, N. C.

I am convinced that most papers on infant feeding, if ihej
deal at all with percentage feedings, are made too technical
for practical application at the bedside. The formulae are so
complicated that the busy practitioner has no time to study
them out, nor has the average mother the ability to apply
them. In what I shall say to-day I hope to omit everything
that will not be perfectly simple. The greatest trouble with
any formula for the modification of milk is the difficulty of
having it properly applied in the homes. The problem of
feeding young infants and older infants with impaired di-
gestive power continues to be one of the most difficult we are
called upon to solve.

Perhaps the main reason for this difficulty lies in the fact
that the proteid of cows' milk differs in so many respects from
that found in human milk. Not only is the proteid percent-
age a great deal higher but it differs in its curding property,
in its chemical constituents and in its solubility. Notwith-
standing the enormous amount of study and experimenting
that has been done no one has found a perfect substitute for
mothers' milk. There is a constant advance being made,
however, and each step taken brings us nearer the goal.

The first step forward was taken when the pediatrist began
combining cream, milk and water in such proportions as
would make the percentages of fat, sugar and proteid con-
form mathematically to those found in mothers' milk. These
combinations seemed to meet the indications in a great many
cases, but the similarity was not perfect. The resultant
formula was not such as would produce a food of sufficient
nutritive value to cause a normal child to grow and develop
in a normal way. There were not enough heat calories in the
mixture; then, too, the most serious difficulty was not re-

N. C. MEDICAL SOCIETY. 693

moved. Many babies could not digest the proteid in the mix-
ture; this trouble was mitigated somewhat by rendering the
milk alkaline with lime water or citrate of soda. The chief
proteid of cow's milk, caseino gen or calcium-casein, forms
about 2.66 per cent of the total proteids ; the balance, .84 per
cent, being soluble proteids. This calcium-casein combines
with the hydrochloric acid of the stomach to form calciimi
hydrochloride, setting from the base free casein. This casein
combines with more of the acid to form the curd of milk as
we see it. If sufficient alkali be given the base free casein
forms with it a soluble compound, which does not curd with
the acid, nor is it acted upon by rennin ferments. But the
alkaline milk solution passes on into the intestines to be di-
^gested there by the intestinal juices. The secret in this pro-
cedure lies in the fact that, being soluble, the milk passes
into the intestines much more rapidly than if it is allowed
to form a curd in the stomach and the stomach allowed to do
its part in the digestive process. This explains the action
of lime water and why a child can digest a larger percentage
■of proteid when the milk is rendered alkaline by its use.

AMiile this second step was a distinct advantage in certain
cases, it is a departure from nature and prevents the stom-
ach from doing its share of the work of digestion. Dr.
Chapin, of Xew York, has proven that one object of the curd-
ing of milk is to develop the power of digestion in the infant
stomach. Hence we do not wish to allow all the proteid to
pass undigested out of the stomach into the intestines. Rec-
ogiiizing the difference in the curding property of cows' and
human milk, the curd from the former being tough and hard,
while that from the latter is soft and flocculent ; the next step
forward was to add some dilutent to milk in place of water
that would change the curding property in such a way as to
render it more like that found in human milk. After con-
siderable investigation came the use of cereal gruels; the ad-
•dition of barley, rice or oatmeal gruel to milk made the curd
soft and o-datinous and enabled the infant stomach to digest

694 FIFTY-FIFTH ANNUAL SESSION

a larger percentage of proteid than it had been able to do by
any other method of modification. By this formula many
babies were enabled to take cows' milk who could not do so
before, and to take it in sufficiently strong proportions tO'
cause them to develop and gain in weight in a normal way.

But we ran up against another difficulty in feeding very
young infants; that was the fact that they had no amylated
ferment with which to digest the starches, and often a train
of symptoms difficult to overcome was set up by them. This
trouble was partially overcome by dextrinizing the starch
with cereo or some starch-converting substance. For babies
whose power of starch digestion has developed this is the best
food w^e have to-day, and meets the indication for a baby
food more nearly than any other known method of milk
modification.

There are still left, however, those very young infants who
can't take starches, and older babies whose power of proteid
digestion is so poor that they can not take any of the milk
foods mentioned sufficiently rich in proteid to cause them to
develop and gain weight.

The studies of Hart and Van Slyke have proven that the
soluble proteids in cows' milk constitute only one-fourth of
the total proteids, while in human milk it is about two-thirds.
There are probably other differences in the caseins in the
two milks which have to do with the difference in their di-
gestibility, but the character of the curd seems to play the
most important role. As we have seen the caseinogen or
calcium-casein in cows' milk makes up 2.66 per cent of the
proteids, the soluble or whey proteids .84 per cent. The whey
proteids are not coagulated by dilute acids such as are found
in the stomach, nor by rennin. The same is true of the pro-
teids in mothers' milk, but the soluble proteids are largely
in excess in mothers' milk. It has been demonstrated that
when w^hey, cream and milk are combined in such propor-
tions that the percentages of caseinogen and whey proteids
conform to those found in mothers' milk that the curd

X. C. MEDICAL SOCIETY. 695

formed in the stomach is soft and flocculent. For that reason
it is more easily digested than the curd fonned from cows'
milk when modified by the addition of water or by the grueia.
This combination of caseinogen and whey proteids is spoken
of as "split proteids." For feeding babies in the earlier
months and those whose digestion has been impaired by wast-
ing diseases, this combination seems to meet the indications
more perfectly than any of the foods heretofore prepared.
The preparation of this food is not more difficult than mak-
ing ordinary gruel and milk mixtures. The only difficult
part of the procedure lies in calculating the percentages of
the different ingredients ; but by means of formulae that have
been prepared by Dr. ^Maynard Ladd, of Boston, it is made
very simple.

To prepare a ]unt of whey you heat a quart of fresh milk
to 100 degrees F., and add two teaspoonfuls of essence of
pepsin, mix thoroughly and allow the curd to form; then
beat up the curd with a fork and strain through a sterile
cheese cloth ; put on ice and cool to 50 degrees F. ; before
adding more milk or cream the whey should be heated again
to 150 degrees to kill the rennit enzyme.

To prepare a whey mixture of low proteid percentage for
a young infant to contain, for example: Fat 1 per cent,
sugar 7 per cent, and proteid 1.65 per cent; you would refer
to the card and pick out a formula with the desired proteid
percentages. For example, formula 23, which is : Fat 4
per cent, sugar 7 per cent, proteid 1 per cent. The percentage
of caseinogen is .75 per cent, soluble proteid .25 per cent. By
reference to this formula we see that it requires five ounces
of 16 per cent cream, one ounce of fat-free milk, one ounce
of lime water, 1.16 measures of sugar, and thirteen ounces
of water. We wish to add all the soluble proteid possible,
so we replace all the water by whey, which gives .90 per
cent soluble proteid. If we desired to add less than .90 per
cent soluble proteid, the number of ounces to be added would
be found by multiplying the number of ounces in the whole

696 FIFTY-FIFTH ANNUAL SESSION

mixture by the percentage of whey proteid desired, less one-
fourth of the proteid in the card formula. For example:

W=Q(Y-|).
W=20 (.90— i|2)=13 ounces.
W=Number of ounces of whey needed.
Y=Percentage of whey proteid desired.
P=Proteid percentage in card formula.
Q=Total number of ounces in mixture.

In starting a baby on whey mixtures it is always wise to
begin with low fats and proteids and gradually work up to
that strength that will cause the proper gain in weight, being
careful to watch the stools for signs of imperfect digestion.

It has been my practice in beginning whey mixtures after
an attack of dysentery, or after weaning, to begin with whey
alone for a day, then gradually add cream and milk until
the proper strength has been reached. The change from that
diet suitable during an attack of summer diarrhoea to any
milk food is often a dangerous procedure for, should the
milk fail to digest, often the whole attack is repeated and
with less strength on the part of the patient to withstand it;
hence the necessity of finding a milk easy for a diseased
stomach to digest and assimilate. The digestibility of this
mixture may be further enhanced by peptonizing the mix-
ture in order to help the stomach to tide over that stage in
which the digestion is practically at a standstill. The treat-
ment of summer diarrhoea lias largely resolved itself into a
question of feeding, and by far the most important step in
prophylaxis is carefully regulating the food before the infant
is taken sick.

While the proprietary foods serve a useful purpose in sup-
plying a temporary food during acute illness in infants, we
are all too ]:)rono to put too much faith in them as a perma-
nent food. The whey and cream mixture is suitable for
young infants especially, and has proven itself superior to
all others in older infants while they are regaining their
power of digestion after summer complaints.

N. C. MEDICAL SOCIETY. 697

There are very few points to be remembered in preparing
whey and cream mixtures, but there are a few that one must
memorize in making any milk food. For example, the num-
ber of ounces of top milk necessary to obtain a given per-
centage of fat, the preparation of the whey and the per-
centages of fat, sugar and proteid required at different ages.
The card prepared by Dr. Ladd is a very useful part of the
pediatrist's armamentarium, and makes the feeding of in-
fants a much more simple matter than it has ever boen
before.

69S FIFTY-FIFTH ANXUAL SESSION

SCARLATINIFORM EEUPTIOJSTS.

BY J. STEVEN BROWN, M.D., HENDEKSONVILLE, N. C.

The fact that many podiatrists advocate a fourth exanthema
Duke's disease, coupled with my observation of atypical
eruptions, form my excuse for this report.

Many times do we see eruptions following the application
of such counter-irritants as turpentine and kerosene. Some-
times these eruptions very closely simulate scarlet fever and
are often followed by a similar desquamation. Just so we
have all grades of erythema and dermatitis arising from ali-
mentary disorders and other local and systemic causes. These
are not infrequently followed by more or less desquamation.
When they occur during a scarlet fever epidemic the differ-
entiation is exceedingly difficult. I recall two such cases
occurring during a mild epidemic of scarlet fever. One after-
noon a two-year-old spied a basket of green gTapes, and in
the absence of restraint gorged to his heart's content. That
night nausea and vomiting ensued. The next day a scarla-
tiniform eruption puzzled his physician. There had been no
known nor even suspected exposure to scarlet fever. Not-
withstanding the protest that he and other members of the
family were subject to acute attacks of eczema all members
of the family were instructed to maintain a provisional
quarantine. Under free purgation and boro-carbolic inunc-
tions the itching and eruption finally subsided after two
weeks duration. Some three weeks later decided desquama-
tion occurred. No nephritis nor other complications were
observed. Person and apartments were disinfected. Seven
children older and younger in the house were constantly ex-
posed, after duly cautioning the parents. 'No other cases
developed till nine weeks after the first eruption, a month
after disinfection, when the oldest sister, simultaneously
with several schoolmates who had not been exposed to this

X. C. MEDICAL SOCIETY. 699

case, developed a mild case of scarlet fever. She was isolated.
'No other cases developed. Simultaneously with the first
case and in another part of the same town and under the ob-
servation of another physician another boy ate grapes, riper
but not quite ripe. He too became sick and red and vomited
and puzzled his physician and was isolated for nearly two
weeks, and later had a slight desquamation. Quarantine
having been lifted before desquamation began, a number of
children were associated with him during desquamation, yet
no contagion was reported. Neither of these cases was ap-
parently caused by or causative of or in any way connected
with any of the more authentic cases except as above men-
tioned. Before, during and after these cases there were a
number of cases of scarlet fever reported. Some were com-
plicated with nephritis. Could all these have been Duke's
disease ? or were they scarlet fever ? or were the two reported
cases in no way contagious and due solely to alimentary dis-
orders ?

Too FIFTY-FIFTH ANNUAL SESSION

ILEO-COLITIS.

BY H. L. MONK, M.D., SPENCER, N. C.

Inflammatory diarrhoea, in which in addition to the septe-
mic infection, the symptoms of an acute local inflammation
have a prominent part. — Holt.

Etiology.
Hot Slimmer weather is one of the chief causes of ileo-
colitis, as it is of all bowel troubles of an acute nature, which
is evidenced by the frequent occurrence of epidemics of
frightful mortality and by the statistics from all large cities
in the temperate zone. Whenever the minimum tempera-
ture for the twenty-four hours reaches 60 degrees F. infantile
diarrhoeas of all kinds assume an important part of a medical
man's work. Doctor Ballard claims that the onset of these
<?ases begins when the thermometer registers 56 degrees F.
four feet below the surface of the earth. Age is a most im-
portant factor, and we find most cases occurring between the
ages of six months and two years. Mode of feeding plays
perhaps the most important factor in these troubles, especially
children who are weaned or are placed partially on artificial
food. Mothers take their children from the breast and begin
feeding them on the diet taken by the family or upon a diet
of cows' milk, defective in composition, oftentimes given too
frequently, and in too large a quantity, thus setting up an
indigestion which is oftentimes the starting point of ileo-
colitis. The milk supply is often contaminated, and since
the infant's stomach is deficient in the secretions of hydro-
eloric acid, which by competent authorities is considered bac-
tericidal to the germs taken in the food ; we have infected
milk passing direct into the bowels. Defective hygienic con-
ditions, previous acute diseases, malnutrition in all its forms,
especially rachitis, syphilis and tuberculosis. The prostra-
tion from summer heat, and any special excitement. The

N. C. MEDICAL SOCIETY. 70l

nerve irritation, due to dentition, which has a depressing effect
on digestion, is a prominent predisposing cause of ileo-colitis.
Pregnane}' in some mothers renders their milk indigestible;
if allowed to continue to nurse will oftentimes be the fore-
nmner of this disease.

The Symptoms.
Ileo-colitis usually begins abruptly and for the first few
days can scarcely be distinguished from acute catarrhal
diarrhoea or gastro-interitis. The vomiting is not so jDcrsist-
ent, and the temperature, which is very high in the beginning,
soon drops to about 102 F. and remains about this tempera-
ture, with not very great variations, and the motions are of a
green or greenish-yellow color and are of great frequency.
After two or three days the stools assume a characteristic
appearance. They become of grass-green or brown color,
small amount of blood, a great deal of mucous, very small in
quantity, and the movements are accompanied with much
pain and straining. They may have a slight odor or may be
very offensive and putrid. Microscopical examinations show
undigested food, epithelial cells, pus-corpusles, streptococci
and other bacteria. There is a distinct distention of the ab-
domen, tenderness along the course of the colon, and if you
can secure a sample of urine, you will often find a small
quantity of albumin. If these symptoms persist for a few
days the constant straining will lead to the troublesome condi-
tion of prolapse of the bowel. In favorable cases, in which
proper measures have been faithfully employed in from seven
to fourteen days, these symptoms begin to subside, you will
notice a diminution in the amount of blood and mucous, they
become less frequent, and the pain and tenesmus gradually
subsides and the child's countenance assumes a placid and
contented expression. These cases are nearly always slow in
convalescing and the greatest care is necessary in handling
these cases, as the slightest indiscretion will lead to a relapse
and the inflammatory process go on to ulceration. The per-
sistence for two or three weeks of brown stools and moderate

702 FIFTY-FIFTH ANNUAL SESSION

pyrexia with failing nutrition, are, according to Holt, indi-
cative of ulceration. In this form, the temperature remains
very high, the motions are very frequent, and contain much
blood and the infant soon falls into a typhoid state, in which
you find stupor, delirium, and frequently convulsions. If
the case survives, the symptoms may moderate, but the pros-
tration is extreme, and some pulmonary or cerebral compli-
cation is apt to relieve the sufferer. In these cases recovery
is very tedious and for several months the patient must be
watched. The membranous type is fortunately rare. In
this type the symptoms of the other varieties are exaggerated
with a quantity of blood, and the patient early lapses into a
typhoid state. An examination of the stools under water
shows oftentimes mucous threads, or even pseudo-membranes.

Diagnosis.
This must not be confounded with intussusception. Re-
member that in intussusception we may have vomiting, bloody
stools and tenesmus, and have no pyrexia. Later on the
stools contain no faecal matter. With the tenesmus, the tym-
panites and the stercoraceous vomiting makes the differentia-
tion easy. Typhoid fever is too infrequent in childhood to
require further than a casual mention.

Pkognosis.

The prognosis is dependent upon the vitality and strenglli
of the infant, the hygienic and dietetic conditions that can be
secured, the severity of the attack and the season of the year.
Delicate infants, in unsanitary surroundings generally suc-
cumb early. Continuous high fever, the presence of a large
amount of blood and the severe nervous symptoms with ex-
treme feebleness manifested by weak heart actions are to be
regarded as unfavorable cases.

Prophylaxis.
In no single disease is prophylaxis so important. We as
physicians can do much to reduce the mortality from ileo-
colitis by having our patients to avoid, when practical, wean-

N. C. MEDICAL SOCIETY. 703

ing their babies during hot weather ; by having them feed their
babies, after weaning on wholesome milk and other easily
■digested foods, by avoiding too much exposure to the hot sun,
by keeping them properly clad, by relieving the cases of indi-
gestion and slight diarrhoeas, by thorough ventilation of the
living rooms and providing shade for proper recreation dur-
ing the hot weather. By sending them to the mountains or
seashore or even to a shady country home if child's condition
demands a change, and by looking closely after the acute
eruptive diseases of childhood.

Tkeatiment.
The same general measures are to be employed as in cases
of gastro-interitis. Milk and all milk foods are to be for-
bidden. A full dose of castor oil or an e£Qcient dose of
calomel are to be given at once, followed in a few hours with
a copious irrigation of the colon with a saline solution. The
compress to the abdomen is sedative and is always of service.
After two or three days have elapsed, if the painful strain-
ing persists, one or two drachms of starch water to which a
few drops of laudanum have been added should be thrown
gently into the bowels and retained by pressing the buttocks
together. This will generally moderate excessive peristalsis
and lessen tenesmus. These injections may be repeated every
eight hours if necessary. If the amount of blood is excessive
a pint of hot water, to which one drachm of fluid extract of
hamamelis has been added, should be used to irrigate the
bowel, using a soft rubber tube introduced about six inches
into the bowel and holding the syringe not more than two feet
above the patient. After the acute symptoms have subsided,
tannic acid or a weak solution of nitrate of silver may be sub-
stituted for the hamamelis, and in many cases are of un-
doubted advantage to the patient. During the first few days
five or ten drops of castor oil to two or three drops of pare-
goric given at two or three hour intervals is of great benefit to
most patients. Later, one of the insoluble preparations of

704 FIFTY-FIFTH ANNUAL SESSION

bismuth suspended in mucilage should be added to the treat-
ment and given in doses of from ten to thirty grains. Intes-
tinal antiseptics are of very doubtful advantage and had best
be left off. Tannigen and bismuth in dose of five grains
each given in powder are more astringent and are of value in
cases of excessive diarrhoea. Endoxin and tincture of iodine
are much lauded by many authors, but perhaps are not supe-
rior to regular treatment. French brandy, or any old brandy,
is one of our chief "standby's," and is required in every case
of severe ileo-colitis. Cool baths or alcohol sponges should
form a part of our treatment. The diet should be of barley
or rice water, whey, orange juice, peptonoids, etc. Later in
the attack beef broths followed by peptonoided milk during
convalescence. The serum treatment is much lauded by
many clinicians.

X. C. MEDICAL SOCIETY. 705

PXEUMOXIA IX CHILDREN.

BY J, A. TURNER, M D., HIGH POINT, N. G.

In attempting to offer a paper to the Society on the subject
of Pneumonia in Children, I do so with a full conviction of
mj inability to discuss the subject in the way that its im-
portance demands. ISTor am I induced to try to discuss it on
account of any special knowledge of the subject or for the
purpose of advocating any theory as to etiology or any specific
treatment. But rather on account of my feeling of utter
helplessness when called to treat a little sufferer in the grasp
of this disease, have I felt perhaps a deeper interest in the
management of it than perhaps any other. On account of its
widespread prevalence and its great mortality it is in my
opinion a subject of the greatest importance. Our profession
has since its early history recognized the disease and men of
great accomplishments have studied it with the greatest care,
and still the mortality is little changed in spite of the many
different modes of treatment advocated and pursued. How
often have we been called to the bedside of an innocent suf-
ferer to find perhaps the only child of fond parents or the
bright particular star and heir upon whom the perpetuation
of a family and name may depend, and have our hearts sink
within us when we see the well-kno^vn signs of this disease ?

I shall not attempt to enter into a discussion of the eti-
ology of the disease, for I am convinced that there are many
causes that produce it and that the pneumococci is merely an
incident and not a cause. I shall not attempt to delineate the
varieties of the disease and will speak only of the form most
frequently met with in our daily work. Of these catarrhal
pneumonia is "the" pneumonia of children, during the past
twenty years, or since the great prevalence of influenza I do
not remember to have seen but a few cases of croupus pneu-
monia, not that croupus pneumonia is less rare, but that ca-
45

706 FIFTY-FIFTH ANNUAL SESSION

tarrhal pneumonia is so very common. I do not recognize the
so-called condition of capillary bronchitis.

Symptotnatology. — In catarrhal pneumonia dullness on per-
cussion may be absent, on the first examination, being found
later, scattered over both lungs and more extensive at the
bases, where showers of subcrepitant rales may be found in
abundance. In the course of a few days scattered areas of
dullness, associated with bronchial breathing and moist rales,
indicating atelectasis, are found. Of these some are con-
stant, others appear and disappear, shifting dullness. They
may be small and numerous, or massive and include the
greater part of a lobe or lung. Massive areas are constant.

As these signs develop the symptoms become correspond-
ingly severe, dyspnoea increases, respiration is accelerated to
from 60 to 70, pulse small and fluttering, indicating cardiac
failure, delirium cephalgia, retraction of head, tenderness of
scalp and convulsions, meningeal symptoms, due to the toxic
effect of the disease on the brain ; i. e, that the symptoms re-
ferable to meningeal envolvement are due to a toxfemia re-
sulting from the disease, and not from the disease per se.
This conclusion is substantiated by post-mortems, in that they
show only anaemia of the brain and its membranes, without
evidence of inflammation. Clinical evidence further corrob-
orates this, in that the symptoms are directly increased in
proportion to the extent of the disease.

Fever ranges from 99 to 104 4/5 F., in ordinary cases, and
as it is only the uncomplicated cases that I shall consider in
this discussion, those which are secondary in character, being
of necessity altered in their symptomatology by the preceding
or concurrent disease, I shall likewise avoid in my consider-
tions.

Prognosis. — Pneumonia in any form and at any time of
life is a dangerous disease, but it is especially so in children.
Statistics show as great a mortality as 85 per cent in cases
that occur in the first years of life, and diminish with age.
The previous condition and the surroundings should not be

N. C. MEDICAL, SOCIETY. 707

overlooked or forgotten in the prognosis, and in a Rachitio
-case should be especially guarded. This disease having no
definite limit or cycle, is little influenced by treatment, as to
time of termination.

The management of patients suffering with this disease I
<;onsider to be entirely individual, each case demanding a
treatment in the main different from the other. Some of tJie
worst cases that I have seen recover have done so practically
■without medicines or other therapeutic measures. I have in
mind at present the instance of a bright little boy, the son of
an highly esteemed confrere, who positively refused medicines,
food, water, and interference of any kind for days, making a
perfect recovery, and during this stage of his illness was sup-
posed to have had brain complications. This is only one of
a number of similar cases and is referred to especially as
being of that class of refractory cases so often met with in
our experience.

The first point to which our attention is called is that of
fever, cough, difficult and rapid respiration. These symp-
toms, we are inclined, as are the parents, to look upon as the
•disease rather than the effects of a morbid condition going
on in the system that produces them. The fever is the con-
dition that first calls for attention in the majority of in-
stances, and unless wisely and prudently managed is the point
in the battle where we weaken and exhaust the forces upon
which the recovery of the patient depends.

Antipyretic treatment is the first considered, viz, medicines,
and the local application of cold. The first is the more con-
venient, and to the parent the most satisfactory, as the child
will resist a palatable dose of medicine less than the applica-
tions of cold. They are, however, delusive and harmful in the
end, and if used, should be with the gTcatest caution and care.
Of these the coal tar products are the most active and conse-
quently the most dangerous, and their administration should
be attended with greater caution than some of the less active
preparations. Aconite and veratrum perhaps are next thought

Y08 FIFTY-FIFTH AIs^NUAL SESSION

of, and each have their advocates by men of judgment, skill
and reputation. To me each has been disappointing and
discouraging. In no instance should the coal tar antipyretic
be given, except in those cases of hyperpyrexia, with impend-
ing or active convulsions, and then only when cold applica-
tions can not be applied. Aconite and veratrum are little less
indicated and equally dangerous. I prefer cold packs, ice
bags, to the chest, when the temperature goes above 103 F.,
cold sponging to back and chest with water, with towels
wrung out in ice water to the head.

The disease having no definite limit, and running no cycle,
the tendency being to destroy the vital powers, and the time
of termination being little influenced, by treatment other
than that directed to the support of these failing powers and
to the maintenance of the secretory and excretory functions.

It is my opinion that the use of cardiac stimulants and
tonics should not be delayed for a longer time than the first
evidence of overwork of the heart, viz: small, rapid pulse,
with cynotic symptoms, resulting in the venous system be-
coming overloaded with the circulatory fluids, due principally
to failure of the capillary circulation, from vasomotor
paralysis. The remedies which I have found to be the most
useful in combating this condition are digitalin (merk) in
combination with strychnia, and these being pushed to their_
full physiological effects. Should more powerful stimulants
be called for or demanded, it has been my custom to rely on
hypodermics of camphor and oil.

Ammonia perhaps has its place, being not only a cardiac
stimulant, but one of respiration as well, and further, for its
effect in decreasing the amount of fibrin ferment in the
blood, thereby lessening the liability to heart clot.

Mercury I believe to be indicated, for its influence on the
secretory functions, especially of the liver, as much depends
on the destructive power of this organ, on the existing toxins,
and is perhaps not without its good effect as a solvent of the
inflammatory exudates of the lungs. It should be given with

X. C. MEDICAL SOCIETY. 709

prudence and care. The best results are obtained from
small and repeated doses.

On account of the hebetude and the partially comatosed
condition, the patient often fails to pass his urine, with thy
consequent overloading of the bladder, adds greatly to the
discomfort of the patient, and should not be neglected.

The bowels should be kept open by the use of castor oil or
enemas of saline solutions, the latter supplying the deficiency
of fluids caused by the exhausting fever and its stimulating
and antitoxic effects upon the system. In the event that
diarrhcea should supervene, an effort should be at once made
to correct the same, by a change of diet and by such remedies
as may be indicated.

Owing to the exhaustive character of the disease and the
23robability of its long continuance, the powers of the stomach
should be carefully guarded, and only such nourishment as
is easily assimilable, and which makes the smallest demands
upon its digestive functions should be administered. That
these conditions be fulfilled, it will be found necessary to limit
the diet, and in the main this should consist of liquids, as
milk, broth and partially cooked eggs.

Surroundings. These are mentioned last on account of
their importance. It is now conceded that in all pulmonary
diseases an abundance of fresh, cool air is of paramount im-
portance. To obtain this the bed should be so located that
the face and head of the patient shall be exposed to the free
circulation of the uncontaminated air of the outside ; the
body and limbs being protected by appropriate covering that
is both light and warm.

"Sleep and quiet, being important essentials as to the wel-
fare of the patient, it becomes necessary that his food and
medicine be given at definitely stated periods, and only on
these occasions should any disturbance be permitted, and no
one except the attendant in charge should be permitted to
remain in the room.

710 FIFTY-FIFTH ANNUAL SESSION

PLEURISY m CHILDREi^.

BY J. R. Mccracken, m d., waynesville, n. c.

In considering this snbject, it is not my purpose to enter
into a detailed description of all the different forms of pleu-
risy that are seen in childhood, as all the forms seen in the
adult are seen also in the child, and as to the pathology of
the disease there is no essential difference between pleurisy
in adults and pleurisy in children, the principal difference
being one of etiology.

According to Holt, dry pleurisy as an independent clinical
disease has no existence in infancy or early childhood, being
always secondary to affections of the lung, and some authors
doubt if it ever occurs as a strictly primary disease. As in
the adult most cases of pleurisy are secondary to diseases of
the lung, and in infants this is perhaps true in 90 per cent
of all cases. It is occasionally seen complicating, or as the
sequel of some of the acute infectious diseases, such as scarlet
fever, measles, typhoid fever and influenza. In adults tuber-
culosis is perhaps the most important etiological factor, while
in children, and especially before the seventh year, this is an
exceedingly rare cause. This, perhaps, accounts, in a degree,^
for the fact that the seemingly ])rimary cases occur so much
more often in adults than in children, and may also account
for the fact that the dry and sero-fibrous forms, the forms
most often due to tuberculosis, are most frequently seen in
the adult, while empya?ma, or the purulent form, is more fre-
quent in the child. Among other causes of pleurisy might
be mentioned necrosis of a rib and traumatism.

Since dry pleurisy is exceedingly rare, and pleurisy with
serous effusion not at all frequent in children, we will pass
at once to a consideration of empysema, the form most often
seen in childho<id and the most important form of pleurisy
with which the physician has to deal. Perhaps 90 per cent
of these cases occur with, or follow pneumonia, being a com-

^^. C. MED3CAL SOCIFIY. 711

plication of that form known as pleuro-pneiimouia. In my
opinion this is as often overlooked, or unrecognized, as any
serions affection of childhood, as so many physicians dismiss
their jjuenmonia patients so shortly after they have passed the
crisis, and in cases where dullness and irregular fever persists,
too many physicians are willing to satisfy themselves with the
belief that they have an unresolved pneumonia, and that a
little time will make it all right, thus letting them go on to a
fatal termination when by a little effort and timely interfer-
ence life could have been saved.

As to the symptoms, physical signs and diagnosis of this
condition, I have nothing to add to that which may be found
in most any text-book on general medicine, or diseases of
children, but I would emphasize the importance of the use of
the exjiloring needle in making a positive diagnosis. This
should be practiced in every case where there is a suspicion
of fluid of any kind, as it is a simple procedure, unattended
by any great pain, and the dangers are so slight as hardly to
be considered. Simply introduce the needle between two
ribs, preferably the seventh and eighth, in the middle or pos-
terior axillary line, and draw the piston of the syringe. If
the result is negative repeat the procedure in a different loca-
tion, as the fluid might be sacculated and not reached by the
first attempt. I use a glass barreled syringe and a long needle.
In introducing the needle I push till I fail to meet resistance,
then draw the piston. If I fail to get fluid I unscrew the
syringe, leaving the needle in place, replace the piston, screw
the syringe back to the needle, and push the needle in till I
am sure it has passed through the chest Avail, then gradually
withdraw the needle, drawing the piston at the same time,
and if there is fluid present I am most sure to get it. This
may seem a small matter to go into details about, but we
don't want to be introducing the needle more times than we
can avoid, and we do not wish to be introducing air into the
pleural cavit}' when it is not necessary. In children a needle
three-fourths of an inch long will usually be found of suffi-
cient lenath.

712 FIFTY-FIFTH ANNUAL, SESSION

The prognosis of empysema in children under one year old
is particularly bad, the mortality, according to Holt, about
75 per cent; in children over two years old, when seen reason-
ably early and receiving proper treatment, the outlook is
fairly good. This is especially true in the case complicating
pneumonia, the recovery in these cases being often surpris-
ingly complete. In the cases complicating typhoid and scar-
let fevers, the outlook is much more serious, since in these
cases the condition is so often due to streptococcus, or to a
combination of the streptococcus and the staphylococcus, these
being much more virulent germs than the pneumococcus.

Spontaneous recovery by absorption may take place, but
this is so rare that it should not be hoped for. The pus may
be evacuated by rupture through the visceral pleura into a
bronchus and may be coughed up. This is the most favorable
method of spontaneous evacuation. Other means of natural
termination are by burrowing through the chest wall and
forming a pointing abscess, by rupture into the oesophagus
and by opening through the diaphragm into the peritoneal
cavity and appearing as a psoas abscess.

Out of 19 cases of empysema reported by Schmidt, in which
there was spontaneous discharge of pus, 17 died and 2 recov-
ered. Of 32 cases reported by Rilliet and Barthez which
received no surgical treatment, 21 proved fatal. Xathan, of
one of the German hospitabls, reviews 145 cases of empysema
in children observed during an attendance of 13 years, the
mortality in infants under one year old being 97 per cent, the
lowest mortality being 25 per cent, this being in children be-
tween eight and nine years of age. Out of the 145 cases 43
were cured and 93 children died, the others remaining dis-
eased. It is interesting to note that the author followed up
the histories of 34 cases discharged as cured and found their
condition good. Only two were afterward found to be sub-
ject to tuberculosis, this proving our statement that tubercu-
losis doesn't play the part in pleurisy of children that it does
in pleurisy of adnlts.

N. C. MEDICAL, SOCIETY. 713

Empysema is almost purely a surgical disease, but it is well
to give some tonics and to order an easily digested, nourish-
ing diet; the medicines used are principally to build up the
condition of the patient, and I have found good results from
a preparation of cod liver oil containing creosote and guiacol.
In my opinion the pus should be evacuated as soon as it is
found to be present, provided the condition of the patient v^^ill
permit, though some physicians prefer to wait till the period
of acute inflammation has subsided, as shown by lower tem-
perature and stationary physical signs. Aspiration as a cure
for empyema is a failure, and is now rarely employed except
in cases where an immediate operation can not be done and
the symptoms are urgent; in such cases it is employed for
temporary relief only. Simple incision with drainage is the
operation most often employed, and while I do not intend to
go into the technique of the operation I will mention some
precautions that are important and should be regarded. The
incision is often made too short and the drainage tube often
too soft and too small. The incision should be at least one
and one-half inches in length; for when short the action of
the intercostal muscles bends and compresses the tube and
causes it to become plugged. Many physicians make a mis-
take in using a tube too small ; in such a case drainage is not
free and a small tube is much more liable to become plugged
with fibrin. The tube should be made of heavy rubber fene-
strated and as large as the width of the intercostal space will
accommodate ; if it is a half inch in diameter all the better.
Holt advises the practice of introducing two tubes side by
side for the first few days. This diminishes the danger of
having a tube plugged with fibrin and also diminishes the
chances of having a tube compressed between the ribs or by
the action of the muscles. Two tubes having more resistance
than one. I have wondered why we do not have a specially
■constructed tube for the purpose, made of hard rubber fenes-
trated and having a thick, close-fitting, soft rubber shield to
rest against the side when the tube is introduced : with a tube

714 riFTY-FIFTH AA^NUAL SESSION

of this kind there would be uo danger of compression and the
only objection I can see to such a tube is that it might pro-
duce erosion of a rib. The usual duration of the discharge
in cases treated by simple incision is from three to six weeks,
the average being about five weeks.

The operation of resection of a portion of a rib is advised
by some surgeons as a routine practice; but in my opinion, if
the precautions I have mentioned are observed this is neces-
sary in only a limited number of cases, the indications for
resection being overlapping of ribs, or very narrow intercostal
spaces. In some chronic cases which have been neglected and
in which the lung is bound down by firm adhesions a still
more radical operation is sometimes required, that of remov-
ing portions of several ribs, and is known as thoracoplasty, or
the operation of Estlander. After drainage is established in
cases of empya^ma in children, I think it advisable to encour-
age expansion of the lung by some form of respiratory gym-
nastics. The apparatus of James is both simple and effective
for this purpose. It consists of two bottles with perforated
corks connected by a rubber tube. One bottle is placed
higher than the other and the child, by means of a blowing
tube, forces a colored fluid from the lower into the higher
bottle and allows it to siphon back. This amuses the child,
encourages expansion of the lungs, and causes the expulsion
of the fluid from the cavity. These cases often make a sur-
prisingly complete recovery and in an incredibly short time.

Case 1. — On February 13, '08, I was called five miles in
the country to see a boy and found him suffering with pneu-
monia in the lower lobe of the left lung and also severe pleu-
ritic pain. On the second visit I found the right lung in-
volved also, pain in that side, however, being very slight.
The pneumonia ran the usual course and the crisis occurring
on the eighth day, and it seemed that he w^as going to make
an uneventful recovery, notwithstanding the fact that dull-
ness persisted in the left side. In about five days he began
to have a second rise of temperature, and I discovered that

X. C. MEDICAL SOCIETY. 715

the left side was gTadually filling with fluid. After trying
diuretics and other means to encourage absorption for a few
days, I introduced the exploring needle and got a syringe full
of pus, and on the following day, March 4, I operated under
chloroform anesthesia, doing a simple incision. The general
condition of the patient at once began to improve and in about
five weeks the tube quit discharging. This case was compli-
cated by a large abscess just below the right clavicle, making
its appearance about five days after the operation. After in-
cision and drainage it discharged quite freely for about a
week and healed. To make sure that I had not overlooked
an empya^ma in the right side, and that this abscess had not
originated in an effort at spontaneous evacuation, I introduced
the needle into the right side of the chest and got nothing but
a few drops of serous fluid. By the time the tube quit dis-
charging the patient had almost regained his foraier strength.
This boy was in my office about one month ago and said he
was entirely well and could tell no difference between his right
and left sides.

Case 2. — On March 19, 'OS, I was called in consultation
with a physician seventeen miles in the country to see a little
girl four years old. The history of the case as given me by
the physician was that about eight weeks previous to that time
he had been called to the child and found her suffering with
typhoid fever; that the fever had persisted for about four
weeks and gradually declined, the temperature some days
prior to calling me being subnormal. I found the child very
much weakened and emaciated. Upon examination of the
abdomen the results Avere negative, but when I passed to the
chest I soon discovered that the right pleural cavity was filled
almost to the clavicle with fluid, and upon using the needle
found it to be pus. The intercostal spaces were very narrow,
and I was at once convinced that the best method of operation
was to do a resection ; but this I was not prepared to do, hav-
ing with me only a small pocket case of instruments and
seventeen miles from town ; so thinking that I might get good

Y16 FIFTY-FIFTH ANNUAL SESSION

results, I did an incision under primary chloroform anesthe-
sia. I kept the wound open for several minutes by pressing
the ribs apart with forceps and evacuated most of the pus
before putting in the tube ; the tube was small, made of a
soft rubber catheter, but it seemed that drainage started up
nicely. I left instructions with the phjsician to watch closely
and if the tube didn't keep up drainage to notify me. I was
very much encouraged when he repoited next day that the
tube was discharging freely and the patient doing well. I
had no further report until a week later, when I heard the
little girl was dead. The report coming to me was that the
matter all ran out and tube quit dischaiging on the second day
after the operation, but that the patient was so weakened by
the fever and the abscess that she just couldn't get well. I
leave you to draw your own conclusions, and I censure myself
as well as the other party, for in this case a resection should
have been done even if it was inconvenient to do it.

N. C. MEDICAL SOCIETY. 7l7

EEPORT OF A CASE OF PSEUDO-LEUCOCYTHEMIA
INFANTUM.

By JAS. A. TURNER, M.D., AND WM. M. JONES, M.D., HIGH POINT, N. C.

In reporting this case we do so for two reasons: first, on
account of its rarity, as it has been only a very few years
since Von Jaksch demonstrated that it was a separate and dis-
tinct disease, the records are therefore very meager as to
cases; second, for the fact that it has not been a secondary
condition, or sequence of any long wasting disease, and also
for the fact that recovery has been complete.

In 1889 Prof. Von Jaksch, with Monti and others, conclu-
sively demonstrated the fact that this was a separate and dis-
tinct pathological condition, from other forms of Leukaemia;
and it has for this reason been called Von Jaksch's Disease,
or ansemia pseudo-leuksemia of infants, etc.

Case. — M. J ; female; six (6) months.

Family Histoky.

Father of the better class of day laborers; age, 31 years;
specific history, negative; strong and healthy; no history of
any inherited or constitutional disease.

Mother; health good; age, 20 years; has had two children;
specific history, negative; no appearance of any wasting dis-
ease ; labor normal and easy in both cases ; no complications
following; both breast fed.

Brother ; age, 2^ years ; strong and robust ; has always had
the very best of health ; teeth developed early and uniformly ;
no appearance of rachitis.

Pkevious History.

Birth, normal ; mother fed. Thought to have been an espe-
cially healthy child until it was three (3) months old, when
the present trouble began.

718 pifty-fifth annual session

Present History.

On about January 18 ult. mother noticed that the chiia
had what appeared to be a slight cold, for which she adminis-
tered the ordinary household remedies without effect. On
the 20th ult. a physician was called, who pronounced the case
one of pneumonia, for which he treated it until the 10th day
of February, at which time a large swelling was noticed in
the left side of the abdomen. This was treated as an abscess
of kidney, with hot poultices, etc., and later as a nephroptosis.
On February 15th w^e first saw the case.

Appearance. — That of extreme anaemia, the features having
more the appearance of wax than of flesh and blood, coujunc-
tivse very pale, as were all mucous membranes. Child was
very weak, so much so that it could not lift its hands, and
when it cried, it was a very feeble effort.

Physical Development. — Head and face normal, with the
excej)tion of one eye, which was a little smaller than its fellow.
No evidence of any post-nasal, laryngeal or pharyngeal ab-
normalities or the existence of any pathological condition af-
fecting the same. JSTeck and chest were well developed, as
were also the arms and legs. Abdomen was somewhat en-
larged, and on the left side was a large tumorous swelling or
enlargement, which filled the entire left lumbar and iliac,
and extended anteriorly almost to the median line. There
was no redness or other discoloration of the skin, other than
that affecting the whole body. Child was not able to rest
except when placed on its back. A few fine, moist rales were
heard over portions of the chest, both front and back, respi-
rations were accelerated, but without movement of the alae
nasse. Pulse, fast, weak, and of small volume. Tempera-
ture, 101 F. Upon palpation of the large mass in the abdo-
men, it was found to be tender to the touch, as the child would
always cry out; it was smooth and firm, and permitted of
only slight mobility.

Blood Examination. — A very decided reduction in the per
«ent of haemoglobin. Leucocytosis very greatly increased;

N. C. MEDICAL SOCIETY. 719

the exact proportion, however, was not definitely recorded.
The cells observed were large polyniiclear neutrophils and
large mononuclears, which presented great variation in fonn
and staining. Poikilocjtosis was present, but to no marked
degree; a few nucleated reds were also seen.

Diagnosis. — Pseudo-leucocythemia infantum.

Treatment. — Arsenic and iron.

Result. — Complete recovery.

720 riFTY-FIFTH ANNUAL SESSION

COXA VARA.

BY WILLIAM MONCUBE, M.D.,

Instructor in Orthopedic Surgerj', University of N. C. Medical Department, Assist-
ant in Surgery, Leonard Medical School, Raleigh, N. C.

I present this subject with, report of a case: first, on ac-
count of the rarity of the condition, and, second, because of
its importance in the diagnosis of all hip-joint affections.

We do not find a great number of cases of coxa vara re-
ported, but it does occur often enough to become an im-
portant factor in differential diagnosis of coxitis.

In regard to the etiology and pathology of this affection,
I may say that cases have occurred in the course of acute
osteomyelitis, osteomalacia, rachitis and otitis deformans.
A certain number results from green stick fracture of the
neck of the femur and separation of the epiphysis between
the head and neck. Trauma may also operate in the produc-
tion of coxa vara when we have a complete fracture of the
neck uniting with shaft at a right angle or less vicious
union.

There is a group of cases that arises without any assign-
able cause other than softening of the bone from undue hy-
persemia accompanying very rapid growth in adolescence.

Given one of the above causes, we have the normal resist-
ance of the neck of the femur reduced until it is no longer
able to bear the strain of body weight. It then bends down-
ward until the neck and shaft form a right angle or less,
thereby elevating the trochanter and considerably shortening
the limb.

With age and sex we find normal variations in the angle
between the shaft and neck of the femur. When the angle
becomes a right angle or less, marked symptoms of deformity
appear, and we term the condition coxa vara, in contradis-
tinction to coxa valga, where the axes of the neck and shaft
approach a straight line. The condition is essentially one of

X. C. MEDICAL SOCIETY. 721

growing bone and may affect one or both legs. It seems to be
met with oftener in males than females.

Symptoms.

The onset is usually insidious, without symptoms until
the deformity is well advanced. There are very few subjec-
tive symptoms, and when they are present they consist chiefly
of pain and discomfort in the hip joint with a disinclination
to use the limb. When the condition is unilateral the short-
ening is very noticeable, varying from one-half to two inches.
The trochanter is well above i^elaton's line.

When the affection results from epiphyseal separation, we
may expect the shortening to become more marked as the
individual grows older.

^lotion in the hip joint is limited chiefly in abduction, be-
cause the trochanter is driven against the rim of the acetabu-
lum or the surface of the ilium just above it. After exces-
sive use of the limb in its deformed position, the irritation
may be sufficient to give rise to moderate muscular spasm,
resulting in flexion and external rotation. The shortening
causes a most decided limp.

According to the forward or backward bending of the neck
of the femur, we get eversion or inversion of the foot. Some-
times in unilateral cases we notice lateral curvatures of the
spine.

Diagnosis.

This is usually not difficult and depends largely on the
examination. When we find the trochanter well above E'ela-
ton's line, shortening by comparison with the sound side and
limitation of motion in abduction and rotation only, an al>
sence of effusion or other inflammatory symptoms, we can
safely make the diagnosis of coxa vara. A radiogTaph will
always make the diagnosis positive.

Bryant's triangle will locate the shortening in the neck of
the femur. AMien the condition is bilateral the diagnosis is
more difficult and may have to depend entirely on the radio-
46

722 FIFTY-FIFTH ANNUAL SESSION

graph. In its incipiencj tubercular hip disease may be eon-
fused with coxa vara. In "hip disease" the subjective symp-
toms are always more marked and motion is restricted in all
directions ; the nerves supplying a joint supply the muscles
surrounding that joint. The limitation of motion in "hip
disease" is due to muscular rigidity, while that of coxa vara
is mechanical from the elevated trochanter impinging against
the ilium.

The shortening of "hip disease" is only apparent until very
late in the process, but that of coxa vara is actual, and Bry-
ant's triangle demonstrates the fact that the shortening is in
the femoral neck. Coxa vara may complicate hip disease in
its later stages when the bone becomes "worm eaten" and
thereby unable to sustain the weight of the body without
bending.

Congenital dislocation of the hip may also be mistaken
for coxa vara. In congenital dislocation the head of the
bone is not in the acetabular cavity and can be found in
an abnormal position. In coxa vara the head of the bone is
in the acetabulum and the trochanter moves through a
greater arc in rotation. The reverse is the case in congenital

dislocation.

Pkognosis.

This varies with the etiology, but in general is very good
as to restoration of function. After the bone becomes ossi-
fied in a deformed position we can not expect to get improve-
ment without some form of operation.

Treatment.

If the case comes under observation early when the bone
is soft and yielding, the first indication is to remove the body
weight with crutches or apparatus. When it occurs in the
course of a general disease as rickets, in addition to the, con-
stitutional treatment, it is necessary to maintain forced ab-
duction in a plaster spica bandage.

Regardless of the etiology, when the bones are no longer
pliable, some form of operation is necessary. Linear os-

X. C. MEDICAL SOCIETY. 723

teotomy seems to offer the best prospect of correcting the de-
foi-mitj and restoring nonnal abduction to the limb. In
order to avoid entering the joint cavity, section of the bone
is made just below the trochanter minor.

Cuneiform osteotomy has two serious objections : first, loss
of bone followed by shortening, and, second, the greater
amount of tissue-dissection necessary to expose the bone.

Report or Case.

L. H. (col.), aged 12 years, St. Agnes Hospital, Raleigh,
March 15, 1908. Well nourished, healthy child, complain-
ing of nothing except an aggi-avating limp. She has not had
rickets nor an injury. Mindful of the fact that fracture of
the neck of the femur is more common in the young than is
generally supposed, the history was carefully searched for
trauma, but without avail. Previous to December last noth-
ing unusual was noticed, the child appearing normal in every
respect. Since that time a gradually progressing limp has
been noticed. There has been practically no pain nor discom-
fort in the joint.

On examination there was no difference in the circumfer-
ence of her limbs, but a shortening of two inches on the left
side. Bryant's triangle demonstrates the fact that this short-
ening was in the hip. There was slight eversion of the foot.
The trochanter major was some distance above IvTelaton's line.
The gluteal fold on the left was more marked than on the
right. Abduction was markedly limited by the elevated
trochanter striking against the ilium. Rotation was very
slightly affected. The trochanter moved through a much
greater arc than on the right side. Effusion and other evi-
dences of inflammation in the joint were absent. Other than
limitation of abduction and rotation, there was no interfer-
ence with joint motion. Muscular spasm was entirely ab-
sent. All other bones were normal and did not show evi-
dence of previous rickets. The diagnosis of coxa vara was
made and confirmed by a radiograph, which shows the condi-

T24 FIFTY-FIFTH ANNUAL SESSION

tion perfectly. Under ether a subtrochanteric linear oste-
otomy was done, the limb strongly abdncted and maintained
in plaster. The plaster cast had to be reapplied four times,
because by her carelessness she soiled and ruined each cast
with urine.

During the operation nothing abnormal in the texture of
the bone could be found.

At the end of the seventh week the last cast was removed
and firm, bony union was established. On measurement the
shortening was reduced from two inches to one inch. Ab-
duction was restored and the trochanter was on an exact level
with J^elaton's line. This gives her a much more useful
limb, and I believe the shortening would have been reduced
another one-half inch had she not destroyed her casts so often.
While firm union has taken place, and the bone softening-
process has subsided, she will be kept on crutches a month or
two longer, to guard against a possible return of the con-
dition.

N. C. MEDICAL SOCIETY. 725

AKTIFICIAL INTERRUPTION OF THE PHYSIO-
LOGICAL CIRCULATION AS A THERAPEUTIC
MEASURE.

BY E. T. DICKINSON, M.D., WILSON, N. C.

Through many centuries all therapeutic measures aimed
at reestablishment of physiological functions. This seemed
prima facie sufficient. Remove the cause and correct its
effects is still the therapeutic watchword.

But paradoxical as it may seem it is certain that the inter-
ruption of physiological functions may be used to divert pa-
thological processes. In prophylactic economy the current of
an entire river has been reversed with the greatest benefit to
the public, and it is now beginning to be known that the
various physiological currents of the human body may be
interrupted, diverted and even reversed with admirable thera-
peutic effect.

There are usually some disadvantages accompanying any
interruption of physiological process. Essentially it is a ra-
tional therapeutics based on the choice of the lesser of two
maladies.

Some form of inoculation was practiced many centuries
among the peasantry of South Wales before Lady ^lary "Wort-
ley Montagu came from Constantinople in 1721 and told in
London about the Turkish inoculation for smallpox. In the
highlands of Scotland, too, the practice was not unknown.
There the operation was performed by tying infected threads
about the wrists of children. The antiquity of the custom
among Oriental peoples is well vouched for. Yet it is not
antiquity, but authority which counts in therapeutics, and
the authority of Lady Mary Wortley Montagu and her spon-
sors first gave inoculation a place among thoughtful people;
and this seems to be the first imposition instituted by au-
thority upon the physiological circulation. This opened the
field which looks so attractive from our present point of view

726 FIFTY-FIFTH ANNUAL SESSION

into the wonders of serum and opsonic therapy — fields too
large and soil too rich to be discussed at length in this paper.

The old-time venesector and vesecator worked more wisely
than he knew. He did more than to draw out the poison as
he thought. He interrupted a physiological blood current or
a lymphatic current that had its unsuspected inhibitory effect
in some distant pathological condition. The blister drew not
so much poison from the blood as was supposed, but had its
compensatory effect upon the suffering nervous system.

The treatment for erysipelas, called drawing tlie bloody
fence, was perhaps the first direct interruption of the phy-
siological circulation based on thoroughly understood prin-
ciples. This treatment depends upon the cutting of the super-
ficial lymphatics of the skin entirely around the infected area.
This is a most valuable treatment that has the endorsement
of the highest authority.

During the last fifteen years there has been in process of
quiet development a system of therapeutics based entirely on
various interruptions of the blood current. This has proved
in many conditions of superior and unique value and promises
even now to be in its very early infancy.

This treatment was worked out by Prof. August Bier in
his Berlin clinic. He thought that an inflammation — from
the physiological point of view — does not in itself represent
a diseased condition, but is a phenomenon, indicating the
body's attempt to resist a deleterious invasion.

To increase this beneficent inflammatory hypersemia, re-
sulting from the fight of the living body against invasion, is
the aim of Bier's hyperaemic treatment. His explanation of
inflammatory processes is in direct contrast with many time-
honored views up to the present accepted as pathologic truths.

It has been considered the physician's duty to fight every
kind of inflammation and to look upon them as essentially
detrimental. Bier teaches just the opposite, namely, to artifi-
cially increase the redness, swelling and heat, three of the
four cardinal symptoms of acute inflammation. Hence all

X. C. MEDICAL SOCIETY. 727

means that tend to subdue an inflammation are to be dis-
carded.

It would be too much to consider here the many theories
advanced in explanation of the effect of hypersemia, but it is
interesting to review some of the methods together with the
various pathological conditions in which it has been used with
satisfactory therapeutic effect.

Bier classes hyperaemia as arterial or active, and venous or
passive. Arterial hypersemia is usually produced by heat such
as the dry, hot air that has been in common practice for rheu-
matism and other painful joint affections. Venous hyperae-
mia is induced by a nice degree of obstruction of the circula-
tion of the part as by elastic bandages or vacuum chambers.

The application of the suction apparatus must be governed
by two rules: the procedure should not cause pain; the suc-
tion should be intermittent with three or four minutes suction
followed by one or two minutes intermission. This process
is continued about one-half hour.

Hypersemia by constriction is produced by placing a thin
rubber band or bandage about the part, thus producing a con-
gestion in the portion distal to the constriction. Here also
the process should not be painful.

In our definition of inflammation we have regarded swell-
ing as the cause of pain. Bier and Bitter have decided that
pain ceases when swelling begins. Bitter regards the irrita-
tion of the peripheral nerves by concentrated exudates as the
cause of pain. Artificially produced, congestion diminishes
this concentration and apparently acts as Schleich's method of
anesthesia.

In acute cases the duration of each treatment should be
short, and in chronic cases for a longer period. This method
has been successfully used in all cases of pyogenic infections
and with varying success in tonsilitis, otitis media, epididy-
mitis, orchitis, lymphangitis, arthritis, neuralgia, neuritis,
varicose ulcers, ununited fractures, and persistent headaches.

Dr. Albert C. Geyser, of 'New York, has recently made a

728 FIFTY-FIFTH ANNUAL SESSION

preliminary report of new and physiological methods of treat-
ment of pulmonary tuberculosis based on the principle of in-
duced hypersemia in the lung areas poorly sujjplied with blood
and readily infected with the tubercle bacillus. His report
seems honest and gives a large per cent of cures.

A series of experiments show that the hypersemia induced
in tubercular joints, both by the X-Ray and by iodoform in-
jections, is a large factor in the improvement of these con-
ditions.

This artificial hyperoBmia departure is not claimed as a
cure-all, or a fad for the specialist, but a rational treatment
based upon sound principles, and can be used by every practi-
tioner in his daily work. The more skilled one becomes in
its use, the better will be the results. There will be failure
in some cases, as there would be in any form of treatment,
but it should not be discarded by any without an honest and
intelligent trial.

N. C. MEDICAL SOCIETY. 729

DIPHTHERIA AXD A WORD FOR ANTITOXIC,

RY E. M. HUTCHENS, M.D., BOONVILLE, N. C.

Diphtheria is an infectious constitutional febrile disease
with local manifestation, generally in the throat or pharynx;
it may be, however, in the nares or It^rynx, in the vulva of
females, or it may infect any part of the body where there is
a break in the tissues, especially that of the mucous mem-
branes, 31r. Hare, of Philadelphia, says the disease is at
first local, which soon becomes constitutional by the absorp-
tion of toxins, which is probably correct. It is not my pur-
pose, however, to enter into a voluminous discussion of this
subject ; were I competent, time and space forbid.

Diphtheria has robbed the world of much of its greatness.
It has put out the light of many beautiful and brilliant stars
that were forthcoming to shed rays of intellectual light to
mankind. Many a little bud has been nipped that would
liave made a beautiful flower to adorn and make glad the
home, had it not been for that blighting and chilling little
frost — the diphtheria bacillus. This little germ is especially
fond of children, its greatest affinity being for those between
two and fifteen years of age. Xursing children seem to be
somewhat immune from the disease. It frequently attacks
those in adult life. Xo age is perfectly immune. Second
attacks of diphtheria are rare, but sometimes do occur.

The diphtheria bacillus is a very hardy germ, can live for a
long time without the body. This little germ,, which is the
exciting cause of diphtheria, was unknown to the medical pro-
fession prior to the year 1SS.3. In that year one Mr. Klebs
discovered the bacillus, and his discovery was confirmed by
Mr. Leofler the next year. Hence we have the Klebs-Leofler
hacillus, this name being given to distingiiish and perpetuate
the names of the two great scientists who made the discovery,
a distinction they well merited. Prior to this discovery the
•disease was treated empirically, the mortality death rate being

730 FIFTY-FIFTH ANNUAL SESSION

high, ranging in the different epidemics from 25 to 65 per
cent. The ravages of the disease upon human life was fear-
fuL The physician could only stand by helpless and see the
life of his little patient gradually but surely smoulder out, or
else in his igTiorance of the nature of the malady, and in his
zeal to do something for his patient, make a mop and apply
some irritating substance, trying to mop out the membrane,
thereby opening up the avenues of entrance for the toxins,
thus hastening the termination of his patient.

To take a retrospective view of the past old-time treatment
of diphtheria, after having the modern searchlight thrown on
by eminent pathologists and bacteriologists, revealing the na-
ture of the disease, it is a wonder any recovered under the
old-time treatment. Yet some recovered in spite of both dis-
ease and treatment.

There are two varieties of diphtheria in which, under the
old treatment, the mortality death rate was exceedingly high,
viz : the nasal and laryngeal. In my private practice I have
never seen more than one or two nasal cases, and not one
laryngeal case recover, I have, however, under the modern
serum-therapy treatment, to my glad surprise, seen one case
of laryngeal diphtheria recover. And this case, a very bad
one, I wish to report to this Society. This case was not pri-
marily laryngeal, but became so secondarily, the disease
spreading downward from the throat and attacking the larynx.
The patient was a beautiful little girl, ten years of age. She
was the youngest child, the darling and pet of the family. I
was called by 'phone to see her on October 20, 1907. After
driving a distance of eleven miles over rough roads I arrived
at the bedside of my little patient. I noticed some external
swelling of the throat; upon examination found the tonsils
and greater part of the pharynx covered over with diphthe-
ritic membrane, and the little patient getting hoarse. Pulse,
135; temperature, 101^.

Upon inquiry found some other children in the community
had had sore throat.

N. C. MEDICAL SOCIETY. 731

This little girl had then been sick about five days; the
family thinking it was tonsilitis had been trying home reme-
dies. They did not become alarmed until the child began to
get very hoarse.

I saw at once what a monster I had to deal with, and the
most embarrassing feature about it to me was, I was un-
armed; not having been informed of the nature of the case
before leaving home. Country people take it for granted
that the doctor always has everything he needs right along
with him.

I had one package of 2,000 units of antitoxin at home
which had just run out of date. This I was not willing to
risk for two reasons: it was too old, and the dose was too
small. Had I had it with me, however, I should have used
it. What could I do ?

I instituted the best treatment available. I washed out
the child's throat mth hot salt solution, and instructed father
and mother to do this every three or four hours; gave inter-
nally fifteen drops of the tincture of the chloride of iron, di-
luted in water, every three hours, and 1/60 grain strychnine
sulphate every six hours.

I informed the family of the seriousness of the case, at the
same time telling them I had no hope in any treatment except
diphtheria antitoxin, and not much in that so late in the
disease; telling them the cost of the antitoxin. The father
and mother both said, if there w^as a ray of hope in the anti-
toxin, to order it by 'phone and use it as early as possible
regardless of cost.

So I left the little patient on the above treatment and re-
turned home to order the antitoxin. I ordered two pack-
ages, 4,000 units each. Could not get the antitoxin until
2 p. m. next day. At this hour my antitoxin arrived and
I set off for an eleven mile drive to the little patient, expect-
ing to find it beyond hope. I arrived at the bedside of the
little patient about 3 :50 p. m. She could not speak to me.
Aphonia was almost complete. She could only utter a high-

732 FIFTY-FIFTH AN:XUAL SESSION

pitched whisper, which is so well known to us all who have
once seen these cases of laryngeal stenosis. The little child
was rolling from one side of the bed to the other, struggling
for air, its tissues and life's blood starving for oxygen.
There was a pale, anxious expression of the face. Pulse,
144 ; temperature, 102. The good mother was wringing her
hands with grief, calling on me, with tears streaming, to do
something for her dear child. It looked useless to try to do
anything. I didn't think the child would live until morning,
but I thought I would give it the benefit of the doubt. So I
made ready at once and injected 4,000 units of fresh anti-
toxin, and washed out the throat with hot salt water, (^on-
tinned the iron and strychnine. It was a little past 4
p. m. when I injected the antitoxin and washed out the
throat. At 10 p. m., six hours after using the antitoxin,
improvement was noticeable, the child began to breathe
easier ; and at midnight, eight hours after using the anti-
toxin, it got still and went off into a quiet, peaceful sleep.
Its pulse was better. It slept until about 4 a. m., when it
awoke. I now again washed its throat with hot salt solution,
gave iron and norishment. Its pulse now was much better.
Temperature, 100 ; a drop of two degrees. It again went to
sleep and slept off the morning very quietly.

For diet of this patient we gave milk, eggs and brandy
every two or three hours. After washing throat and giving
nourishment I drove oif for a day's driving to see other pa-
tients, instructing father and mother to wash the child's
throat with hot salt water every three hours, and to give iron
and nourishment every three, and strychnine every six hours.

I returned to the patient between 4 and .5 p. m. ; found it
bright and breathing easy. It was still very hoarse; could
not yet speak above a whisper. Pulse was about 1-30 ; tem-
perature had gone up a little, standing at 101. I washed
out the throat with hot salt water. To my surprise the mem-
brane was shriveling and beginning to peal, several small
pieces coming away with the wash water. I injected 2,000

:V. C. MEDICAL SOCIETY. 733

units more of autitoxiu that was just out of date, having a
package of that size on hand. Spent the night with the pa-
tient ; she slept the greater part of the night ; got a little rest-
less a while before dav. Xext niornins; her breathiny' was
still easy; pulse, 1^8; temperature, 99 4-5, but she remained
very hoarse. After breakfast, about 8 a. m., I washed out
the throat again with hot salt water. This time great sloughs
of membrane came rolling out ; now all symptoms seemed to
be much better, except the hoarseness ; she looked bright, but
could not speak to me above a whisper. This symptom I
did not much like. For fear my little patient might yet choke
up, as I had to leave it quite a distance, I injected 4,000
units more of fresh antitoxin, and left ; instructing the father
and mother to wash throat every three hours with the hot
salt water, continuing iron and nourishment every three hours,
and strychnine every six hours.

Upon my next visit, next day, the little girl had so much
improved she scarcely looked like the same patient. Tem-
perature was normal ; pulse, 100, and good. Upon inspection
of the throat found the membrane had almost entirely disap-
peared. My patient could now talk to me. All symptoms
much better; patient well on the road to recovery. I in-
structed parents to wash child's throat three times a day with
hot salt water, give strychnine, 1/60 grain, before meals, and
15 drops of the tincture of the chloride of iron after meals.
The little patient made an uneventful recovery.

As I have aforesaid in this paper, I have never seen a child'
in the condition this little girl was in but what it died, and
I think that is the usual history of such cases ; they generally
die from suffocation ; and I verily believe this one would
have died had it not been for diphtheria antitoxin. I think
this is one instance in which antitoxin robbed the grave of
its victim. It's true I used other treatment in this case, but
I give antitoxin credit for curing the patient. T have used
this same other treatment in other cases, without the anti-
toxin, and they all died. T believe washing the throat with

734 FIFTY-FIFTH ANNUAL SESSION

hot salt water is of some value in dissolving the membrane^
cleansing the throat, and preserving the tissues. There is
one thing in this ease that should not be lost sight of, and that
is, the late date on which the antitoxin was used — the sixth
day of the disease. Most authorities tell us we need not ex-
pect results at so late a date. But in this case there was
probably no mixed infection, purely a case of diphtheritic in-
fection, as laryngeal cases are freer from mixed infection
than other cases.

The Klebs-Leofler bacillus seems to facilitate the develop-
ment of the streptococcus and staphylococcus. Then we
have a mixed infection. The diphtheria antitoxine will not
•overcome, or neutralize, the streptococci nor staphylococci.
I presume it is this fact why so many recover when the anti-
toxin is used early (the recoveries being more than 90 per
cent), and why the mortality is so high when the antitoxin
is used late. Hence the importance of using it early.

The other cases in which I have used antitoxin, I used it
on the second and third days ; and I have seen the membrane
readily dissolve and come away on the third and fourth days
of the disease. In the few cases in which I have used it I
have seen no untoward effects, and have had no paralysis.
I, for one, am a warm advocate of the antitoxin treatment,
and I think the medical profession to-day owe a hatlift and a
reverential bow to those great men of science, such as Klebs,
Leofler, Behring, and others.

A'. C. MEDICAL SOCIKTY. 735

THl IMPORTANCE OF A THOROUGH KI^OWL-
EDGE OF BIOLOGY, BACTERIOLOGY Als^D THE
CIRCULATION OF THE BLOOD FOR THE SUC-
CESSFUL APPLICATION OF SERUM THERAPY.

BY J. C. GKADY, M.D., KENLY, N. C.

Mr. President and Gentlemen of the North Carolina Medi-
cal Society:

The subject I have selected for my paper is supposedly a
physiological one — the study of the circulation of the blood,
biology and bacteriology, and their relation to serum theraphy
— but should I digress somewhat from the letter of my text to
contiguous subjects, I beg your pardon and kind indulgence
in advance, while I attempt to rehash this old and thread-
bare subject, "Circulation of the Blood," that is so insep-
arably connected with bacteriology and serum therapy. I
do not expect to be able to advance any new ideas along these
lines, but if I can succeed in provoking a discussion of the
subject then the object of my paper will be attained. The
uses of the circulating blood may be summarized thus: It
is a medium for the reception and storing of matter, that is,
oxygen and digested food materials from the outer world
for convenience to all parts of the body. It is also a source
from which all the various tissues of the body may take the
materials necessary for their nutrition and maintenance, and
whence the secreting organs get the constituents of their va-
rious secretions. It is also a medium for the absorption of
deleterious or refuse matters from the various tissues and
their conveyance to the eliminating organs for their expul-
sion lest the system become by auto-intoxication her ovra de-
stroyer.

It seems to me that a thorough and concise knowledge of
the chemical constituents, biological elements, physiological
and opsonic functions of the blood, together with its course
and manner of travel over the system is absolutely indispen-

736 ni'TY-ilFTH ANA" UAL SESSION

sahle and merits our most painstaking study and considera-
tion, if we would elucidate the mysteries and solve the prob-
lems of serum therapy and understand the important role
the circulation plays in physiological and pathological pro-
cesses. As you know, for the last few years there has been
a great tidal wave of chemical and bacteriological research,
sweeping over this country and Europe. The hunum blood
has been subjected to an endless variety of the most critical
and searching tests, and this bacteriological crusade has put
scientists and medical men everywhere on the alert hunting
for a more satisfactory etiology and a more dependable
treatment for the ills that afflict humanity. Medical and
scientific men have been standing with microscope and
chemical retort in hand striving to recognize and capture
the baneful micro-organism or materies morbi that fosters
disease and engenders death, and while as yet the goal has
not been attained many new and startling truths have been
evolved, many false and erroneous theories exploded, and
many valuable improvements added to our rapidly increas-
ing knowledge of bacteriology and serum therapy. Many
of these innovations and improvements are things too that
only a short while ago would have been considered unrea-
sonable and visionary in the extreme, if not downright
medical heresies. Conspicuous among these may be men-
tioned Wright's Opsonic Theory of injecting into the blood
certain specific bacterins or senmis that will so stimulate
phagocytosis or the opsonic power of the white blood cells
that they will become little corpuscular cannibals that will
destroy and drive out every disease germ in sight and render
the system absolutely sterile and immune against them.

So you see how essential it has become in these days of
change and rapid scientific thought and discovery that phy-
sicians should keep themselves thoroughly informed on all
physiological and biological subjects, and especially those
that pertain to the circulation of the blood, bacteriology and
its most powerful ally, serum therapy. The blood being the
principal medium through which and into which the various

N. C. MEDICAL SOCIETY. iOi

bacteria toxins and other poisons must enter tlie system and
find lodgment preparatory to beginning their nefarious work
of tissue poisoning and destruction, we should endeavor to
learn some plan of preventing their entrance, of combating
their presence and offsetting their methods of proliferation
and development. We need to study their individual char-
acteristics and learn their haunts and habits that we may
be able with our antitoxins and blood serums to break into
their strongholds, tear down their fortifications, and drive
them from their intrenchments in the human system, and
at some time in the near future we expect to be able to do
this in almost every case of germ infection by the applica-
tion of appropriate bacterial serums just as we now do by
inoculation with vaccine virus to destroy or counteract that
certain pabulum toxin or what not in the blood that feeds
the germ of smallpox, j^ow, you would hardly expect a
man to recog-nize a pathological condition in contra-distinc-
tion to the physiological one, if he were unfamiliar with the
physiological. Therefore, in order to understand and fully
comprehend serum therapy, one must familiarize himself
with the different influences and agencies that conspire to
bring about its peculiar manner of action; hence the impor-
tance of physicians keeping themselves at all times thor-
oughly informed on the circulation of the blood and its nor-
mal physiological functions, together with a corresponding
knowledge of bacteriology and pathology, as an aid to a cor-
rect understanding of disease and the application of the
serum treatment.

j^ow, inasmuch as the food after digestion becomes ab-
sorbed by the lacteals and lymphatics and is carried by the
portal or lesser circulation directly to the liver, the blood to
that extent becomes an accessory of the digestive process for
the ultimate purpose of nutrition and tissue building, which
process is accomplished by the food elements being conveyed
to the different parts of the body and tissues by the circu-
lating blood current.
47

738 Fli'TY-riFTH ANNUAL SESSION

Here we see what an important part the circulation plays
as a carrier and the power it has and may exercise in the
inoculation and spread of disease germs through the human
system. Should they enter the system by the stomach, they
are carried by the portal circulation to the liver and systemic
circulation through which not only materials for repair are
conveyed but disease germs and curative agents as well, by
being taken up by ingestion and absorption along with the
food and carried through the portal circulation to the sys-
temic circulation and tissues at large.

So we see while the portal circulation is primarily a car-
rier of nutrition, it may also become the purveyor of deadly
disease germs or be utilized for the better purpose of convey-
ing curative agents in the form of antitoxins. Therefore it is
this phase or circulation that we wish to study and strive to
better understand and learn to more frequently utilize as a
carrier of antitoxins and medicaments to the diseased tissues
which, in combination with the ingested and digested food
elements, are transported directly to the liver.

Leaving the liver it then goes to the right side of the heart
^vith its normal constituents and toxins or antitoxins, thence
to the lungs, performing again the same office, and in addi-
tion giving off some of its poisonous gases for oxygen. Thence
it goes to the left side of the heart where, together with its
death-dealing toxins or its life-giving nutriment and medica-
ments, it is poured into the general systemic or arterial cir-
culation, either to poison or to purify the whole life-giving
stream. So you can easily see how bacteria and disease
germs and their antagonistic serums, whether entering
through peripheral lesions or by ingestion and absorption,
can be rapidly assimilated and disseminated by the simple
and normal process of the circulation of the blood, and how
poisonous germs or medicaments that may enter or become
injected into the circulating fluid, either from within or
without may easily gain access to the cells and tissues of the
entire body.

N. C. MEDICAL SOCIETY. 739

Ofttimes the tissues and cells of the body become so weak-
ened and overpowered by toxins and disease germs that na-
ture's unassisted forces are unable to properly police the
system until her diminished and impaired opsonins are re-
plenished and rendered adequate to the task of driving out
these hordes of invading microbes that have entered it and
caused nature's powers to be overthrown and the energy of
her immunizing and opsonic forces to be lost ; then it is that
we may be able by an intelligent understanding of the blood
and circulatory apparatus and the vulnerable points of mi-
crobic life, by the use of hypodermic or intravenous medi-
cations and those which can be administered by ingestion
reach and counteract or neutralize these invading toxins,
ptomaines and other poisons before they become fully estab-
lished in the system.

For, as we have already seen, medicaments as well as
poisonous germs can be rapidly taken up by absorption from
the digestive tract and passed along with the ingested and
digested food to the portal circulation, and thence to the gen-
eral circulation of the entire body, either to the restoration
and preservation of its health-giving functions or to the
poisoning of the tissues and the destruction of vital processes.
So you can readily see how the germs of anthrax, syphilis,
pellagra, tuberculosis, typhoid fever, tlie pneumococcus, the
streptococcus and all that horde of nameless disease germs,
after gaining entrance to the circulation, may rapidly dis-
seminate themselves throughout the body.

ISTow, when we remember that the blood makes a complete
circuit of the whole body every twenty to thirty seconds, then
we can begin to appreciate to some extent the danger and
power of the blood current as a germ-carrier and also obtain
some idea of its importance as a disseminator of curative
serums when injected into its current to stimulate its opsonic
forces to resist disease and keep our bodies to the standard
of health. This process will be accomplished in direct ratio
to the opsonic index of the blood cells, and in proportion as

740 FIFTY-FIFTH ANNUAL SESSION

the tissues receive and contain a normal and suttlcient sup-
ply of healthy blood in every part of her vessels and circu-
latory apparatus.

In this way the requirements for the health of the organ-
ism will be met and the whole scheme of life and health will
resolve itself into the one condition, that we keep the cir-
culation of the blood through the different parts of the body
continually active and the opsonins in the blood up to the
normal standard of their working capacity.

Whereas, should we fail to do this the circulation will at
once become impaired and sluggish, its vital functions al-
tered, its opsonic powers diminished and inefficient to the
dangerous extent that we must immediately multiply physi-
ologically, artificially or otherwise, these deficient opson-
ins, by the injection into the blood of appropriate bacterial
serums, to the end and in such quantities that they will ac-
celerate the action of the heart and circulation and restore
to nature her lost physiological balance, and enable her to
drive out and resist these invading toxins, preserve, main-
tain and perpetuate the health, life and well-being of the
organism against the malign and deadly influence of the
elusive microbe.

Ever since the day Mayerhofer isolated the streptococcus
pyogenes from the blood of a dead puerperal woman, and
Pasteur produced living cultures of the same and demon-
strated it to be the principal cause of puerperal sepsis, it has
been the dream of the profession to produce a serum with
which the poisoned stream of a woman's blood can in some
way be reached either by direct injection into the blood or
by ingestion and absorption through the stomach. I believe
that Mulford and other makers of antitoxins and bacterins
are experimenting in the right direction, and who knows ere
another decade shall pass but that we shall make even greater
conquests over this terrible scourge with blood serums and
bacterins than we have in the past with cleanliness and anti-
sepsis until the horrors of the puerperal state shall become a
byword of the past?

N. C. MEDICAL SOCIETY. 741

I believe that right along this line of serum therapy we
have the richest unexplored field of medical science, and it
devolves upon us as physicians to develop it to the end that
we must familiarize ourselves with and take advantage of
every agency and circumstance that bears upon it, or that
will in any wise aid us in our undertaking-, whether it be the
circulation of the blood, chemistry, bacteriology, pathology,
or any other closely allied subject. We want to study the
hematolytic as well as the antitoxic action of bact-erial cultures
on the human blood, since there is unquestionably a sig-nifi-
eant relation between them not yet thoroughly understood.
We want to obtain a more definite knowledge of the powers
and functions of the anti-bodies found in blood serum and get
a better working knowledge of the germicidal properties of
the normal circulating blood in order that we may gain a
clearer insight into the combining and resisting powers of
healthy human serum.

We have already learned that there is great variation in
the capacity of different normal systems for appropriating
and assimilating immunity-giving serums. And we would
also like to understand the manner by which the babe ap-
propriates from the mother the immune bodies in the milk,
and why it is that when nature-furnished nutriment is sup-
planted and artificially prepared food substituted so many
infants wither and die like tender grass before a killing
frost. By the acquisition of just this one item of knowledge
we may be enabled to wonderfully lower the high mortality
rate among bottle-fed infants. We want to look in at the
open door that leads to a knowledge and explanation of the
normal activity that controls cell multiplication and the pro-
cess which occurs in the circulating blood called autolysis
or self-digestion of inflammatory exudates, and try to under-
stand how the production of these agents or ferments is
brought about and controlled by the system. In short, we
want to study the circulation of the blood in all of its rela-
tions to serum therapy, and serum therapy in all its relations

T42 FIFTY-FIFTH ANNUAL SESSION

to the circulating blood because the two are so closely related,
interwoven and interdependent that to understand the one
we must necessarily understand the other, and the acquisi-
tion of a comprehensive knowledge of both will wonderfully
aid us in grasping the thousand and one intricate and puz-
ling clinical phenomena connected with the blood and serum
therapy.

X. C. MEDICAL SOCIETY. 743

FORMAL SALT SOLUTIO^t . XTS USES AND METH-
ODS OF ADMmiSTRATION.

BY C. A. WOODARD, M.D., DURHAM, N.' C.

In private practice normal salt solution is not so widely
used, but in hospitals it is one of the chief and most fre-
quently used agents. This variance is probably due to the
fact that in hospitals the requisite solutions and apparatus
are always on hand and a nurse or resident ready to insti-
tute the procedure, while in private practice frequently none
of these is available ; hence the habit of the physician of
resorting to various other drugs and measures to the com-
parative exclusion of the procedures which constitute the
subject of this paper.

!N"ormal salt solution is a six-tenths of one per cent solu-
tion of sodium chloride in water. Its alkalinity is of the
same degree as that of the blood, hence its name. When
introduced into the tissues, a vein, or the bowel, no osmotic
interchange takes place, which is, of course, due to the
equilibrium of the alkalinity of the solution and the blood;
or, in other words, the equlibrium of osmotic pressure.

The important effects of salt solution when administered
by one of the methods to be mentioned are to add fluid to the
body, to stimulate the circulatory apparatus, to increase
renal activity and perspiration and to dilute whatever poisons
may be circulating in the blood.

The addition of fluid to the body is indicated in such con-
ditions as severe hemorrhage, severe diarrhoeas, as in cholera
and some cases of typhoid fever ; in shock, in which the pa-
tient becomes exsanguinated as it were in his own veins;
and in conditions in whit?h the blood is charged with poisons
due to improper excretion, faulty metabolism or the activities
of bacteria.

By the addition of a quantity of innocuous fluid to blood
impregnated with poisons the strength of the poisons is di-

744 FIFTY-FIFTH ANNUAL SESSION

minished by dilution ; and, by the increased perspiration and
renal secretion, they are more rapidly eliminated.

Of the procedures I shall mention as methods of adminis-
tration enteroclysis is the simplest and the one most easily
and conveniently used. Xothing more is needed than an
ordinary fountain syringe, a rectal tube and the salt and
water. Sometimes a return flow tube is used ; but this is a
refinement and not essential. The solution should be sterile
and only a few degrees above the body temperature, as high
temperature may excite peristalsis and induce the expulsion
of the solution.

The i^atieiit is placed in the right latero-prone position
Avith the hijis elevated on a pillow and the knees flexed, or
the patient may lie in the dorsal position. The solution hav-
ing been placed in the bag of the syringe, and the tube lubri-
cated, the bag is elevated from two to three feet and the flow
of the solution allowed to begin in order to displace all air
from the tube. The tube is pinched to stop the flow and is
carefully introduced into the bowel beyond the flexure of
the sigmoid. After the tube is introduced into the rectum
its further introduction may be facilitated by relaxing the
pressure on the tube and allowing the flow to begin. This
flow of the fluid distends the rectum and permits the rectal
tube to be gradually pushed further in. As soon as the bag
is empty the tube is gently withdrawn and the ])atient kept
quiet for a few minutes to aid the retention of the solution.
Quantities of from a pint to a quart are generally admin-
istered. But, if irrigation of the bowel is intended, an un-
limited quantity may be used, as the fluid finds it way out
by the sides of the tube or through the return flow, if a tube
of that variety be used. A Kelly pad or some substitute
must be used when irrigation is done, so that the returned
fluid may di'ain into some suitable receptacle.

Hypodcrmoclysis comes next in point of ease of adminis-
tration. This requires much more care in technique and is
best not attempted unless it can be done under thorough

N. C. MEDICAL SOCIETY. 745

aseptic precautions. A fountain syringe may be used for
this, though a glass irrigator jar is preferable. The other
tilings needed are a hypodermoclysis needle or an ordinary
aspirating needle, solutions for sterilizing the skin, and col-
lodion and cotton for sealing up the little wound. It is
highly important that everything used, including the opera-
tor's hands, be sterilized, and particularly the solution.

It is desired to introduce the solution into the loose cellular
tissues beneath the skin; hence the points of election for
the puncture are the abdomen, the axillie, under the breasts,
or the inner aspect of the thighs. The region in which the
puncture is to be made is thoroughly sterilized and a sterile
towel laid over the part to protect it until the other things
are ready. The solution is j^laced in the bag of the syringe
or irrigator jar and the vessel stopped with sterile cotton.
The temperature should not be above lO-I degrees or 105
degrees F. The needle is connected with the tubing and a
little of the fluid allowed to flow to expel the air and warm
up the tube. Then the needle is introduced through the skin
into the cellular tissues beneath and the flow started again.
The bag is elevated from two to four feet above the level of
the patient. If the needle be a large one a low elevation is
sufficient, but if it be a small one it is necessary to elevate
the bag fully four feet to overcome the resistance of the
small caliber of the needle. It is best not to introduce the
fluid too rapidly. Hare states that one dram to each pound
of the patient's weight in fifteen minutes is fast enough.
When one point seems sufficiently distended the needle may
be withdrawn and introduced elsewhere. The quantity of
fluid used will depend upon existing conditions and the re-
sults desired. Ordinarily a pint or quart is used, but often
it is well to watch the pulse and continue the flow until the
pulse improves, if stimulation is desired. The procedure
may be repeated every four, six or eight hours, as indicated.
As suggested alwve the little wound is sealed with cotton
«nd collodion.

746 FIFTY-FIFTH ANNUAL SESSION

The most tedious method to be mentioned is intravenous
infusion. If careful technique be required for hypodermo-
cljsis even more care should be exercised in this case, for
here the fluid is introduced not into the bowel, where it is
absorbed through the intestinal wall, nor into the cellular
tissues beneath the skin, where it is possible for an infec-
tion or solid body to remain local, or air to be harmlessly dis-
posed of, but directly into a vein, into the blood current
which flows to the heart, thence to the lungs, brain and other
important organs. An infection thus introduced may pro-
duce a phlebitis, a general septicaemia or pysemia, or a solid
body (which becomes an embolus when thrown into the blood
stream) may be carried to the lung or other important organ
in the body and produce an infarction, and perhaps abscess ;
or to the brain, producing the same condition or even paraly-
sis. An air embolus thus introduced may reach the heart
in sufficient bulk to produce sudden death, though this is
unlikely. Prictically, however, none of these is likely to
occur if one is reasonably careful in technique.

The apparatus necessary is the same as for hypodermoclysis,
except that a specially designed blunt canula with a shoulder
near its tip is used instead of a sharp needle. The median
basilic or cephalic vein is selected, though some prefer to
use a vein of the leg. After the skin has been sterilized a
bandage is applied about the arm, above the point to be
opened, to constrict the venous circulation and cause the vein
to stand out prominently. The skin over the selected vein is
incised with a scalpel for a distance of about an inch, the fat
divided down to the sheath of the vein, and the sheath dis-
sected free for half an inch. A ligature is applied about the
vein at the lower end of the incision. This together with
the bandage around the arm keeps the vein distended for the
phlebotomy. A ligature is applied about the vein at the upper
end of the incision and left untied. A small incision is made
into the vein and the canula introduced into the opening;
the canula is now pushed in and the ligature tied about the
vein, iucliidiug the canula within its grasp. The bandage is

N. C. MEDICAL SOCIETY. 747

removed from the arm and the solution allowed to flow. The
bag or irrigator jar should be about one or two feet above
the patient and the fluid allowed to flow slowly. An hour
should be consumed in the administration of a quart, for in
intravenous infusion the fluid goes instantly into the circu-
lation and is not delayed for absorption as in hypodermoclysis.

Before introducing the canula the fluid should be allowed
to flow in order to displace the air, and if the canula be dipped
into salt solution before its introduction blood wnll not coagu-
late on its tip as it is introduced.

When as much fluid as is desired has been infused the
canula is removed, the ligature tied, and the little wound
stitched up and aseptically dressed.

As the fluid flows into the vein the pulse and respiration
improve and the fever, if present, is usually somewhat re-
duced. However, in from two to thirty minutes the patient
enters the critical stage. There may be a chill and strong,
rapid pulse and, later, flushing of the face, followed by a
profuse sweat. The respiration may become labored and
there may be increased urinary flow, and even escape of
fluid by the bowel. But after a few hours these symptoms
disappear and the patient gradually improves.

Some of the conditions in which these methods may be
used may now^ be mentioned :

It is well known that in typhoid fever the free use of water
is a valuable aid to the treatment. The administration of
water by mouth may be reinforced by enteroclysis, and, in
severe cases, hypodermoclysis. It may be repeated three or
four times a day with beneflt. In pneumonia, especially
those cases which show profound toxaemia, the same steps may
be taken. In diabetic coma the patient is certainly some-
times restored to at least temporary consciousness. In urte-
mia, or acute suppression of the urine, there is no better ad-
junct to the treatment than the use of these measures. In
desperate cases continuous flushing of the bowel, using unlim-
ited quantities of salt solution, may be used, and sometimes
undoubtedly proves life-saving.

748 FIFTY-FIFTH ANNUAL SESSION

Sometimes in nrajmic conditions it is advisable to with-
draw fifteen or twenty ounces of blood before nsing intrave-
nous infnsion. Caille states tliat enteroclysis will produce
improvement in anaemia even when iron and arsenic, etc., are
excluded.

These measures may be used in any of the acute infectious
diseases, as mentioned in typhoid fever, and particularly are
they of value when for any reason the stomach disbars medi-
cation.

In dysentery and the various diarrhoeas in adults and in
children nothing is a better part of the treatment than wash-
ing out the bowel, thereby removing undigested food and
other irritating and fermenting matter, and retarding to
some degTee the formation of gas. The idea in these cases
is not, of course, the systemic effect after absorption, but
the local cleansing effect on the bowel.

In intestinal obstruction, due to intussusception or im-
paction of faeces, it is feasible to try enteroclysis, using high
pressure.

In cases in which it is desired to add heat to the body
enteroclysis may be resorted to. The solution should be as
hot as 110 degrees F. at least.

In heat-stroke the same method may be used, except that
in this condition the solution used is cold instead of warm. A
temperature as low as 65 degrees F. is compatible with
safety. Marked reduction of pulse follows.

In profound shock and severe hemorrhage salt solution is
one of tlie most valuable agents, if not the most valuable
agent, at our command. In very profound cases intravenous
is best ; in milder cases, hypodermoclysis ; and in very mild
cases, enteroclysis. When the circulation is very weak and
the blood pressure low it may be that the capillaries will not
take up the fluid under the skin. However, if enteroclysis
be used first, the circulation will be stimulated sufficiently
to bring about absorption under the skin.

The injection of salt solution just before chloroform anes-
thesia has been used with considerable benefit to the patient.

X. C. MEDICAL SOCIETY. 749

A largo ({iiantity is used and it is claimed that the patient
can stand more chloroform, comes out from under the influ-
ence of the drug more quickly, suffers less from the after
effects, and recovers more rapidly than when the injections
are not made.

Circulatory depression due to any of the above-mentioned
conditions may be treated by these methods, but, of course,
organic heart disease is not amenable, and in oedematous and
ascitic conditions they are obviously contra-indicated.

The most brilliant results from the use of nonnal salt
solution, however, have been obtained in the treatment of
suppurative peritonitis by Murphy's slow method of proc-
toclysis, together with the exaggerated Fowler position. With-
out going into the history of the development of the method,
it will suffice to say that it has been demonstrated that the
up])er or diaphraginatic region of the peritoneum has greater
and more rapidly absorbing power than that of the lower or
pelvic region. Hence, if a patient be propped up in bed in
a semi-erect position, or better, according to Dr. Stuart Mc-
Guire, if the head of the bed be markedly elevated, the toxic
fluid in the abdominal cavity will be determined by gravity
away from the upper region to the lower, where absorption
is less rapid.

It has also been demonstrated that fluid introduced into
the rectum will find its way, by antiperistalsis, up the colon
to the ca?cum, and there be absorbed. By this means the
relatively dehydrated vessels become filled with fluid and the
peritoneum becomes a secreting surface rather than an ab-
sorlung one. So, if proper incisions be made and drainage
tubes introduced (it is not in my province to go into the
steps of the operation) instead of the peritoneum absorbing
the toxic material the current of osmosis is reversed, the
blood serum is secreted into the peritoneal cavity and the
toxic matter washed out through the drainage tubes.

The procedure may be instituted as follows : An ordinary
fountain syringe Avith the short nozzle may be used. It is
sufficient to introduce the nozzle just within the rectum as

T50 FIFTY-FIFTH ANI^UAL SESSION

the normal tone of the sphincter is sufficient to hold it in
place. The idea is to introduce the solution only as rapidly
as it can be absorbed by the vessels and not rapidly enough
for it to accumulate in the bowel and act as an enema. To
do this it is necessary for the flow to be very slow, or about
a dram a minute. It was formerly difficult to regulate the
flow, but a device has recently been suggested which obviates
the difficulty: Near the bag the rubber tubing is divided.
Into the proximal end a piece of glass tubing is introduced,
the lower end of which has been drawn out into the shape
of a medicine dropper. Into the distal end is introduced
the larger end of a smaller glass tube of the same shape. A
medicine dropper itself will do for this. If the distal and
smaller tube (or medicine dropper) be introduced into upper
end of the proximal or larger tube and sealed with wax, or
washered with a small section of rubber tubing, the device
is complete. The result is obvious. The fluid is in full view
as it flows through the device.' ]!^ow, if a forceps be applied
above this it is manifest that one can regulate the rate so that
the solution merely drops through. By counting the number
of drops per minute one can calculate the exact quantity of
solution that is introduced per minute or hour. If it is
found that the solution is passing in more rapidly than it
can be absorbed, and is, therefore, accumulating in the bowel
and acting as an enema, the nozzle may be withdrawn until
the rectum becomes quiet and then reintroduced. This pro-
cedure may be continued for days. Owing to the slow flow
it is necessary that the fluid in the bag be kept very hot else
it will be cold by the time it reaches the rectum.

The adoption of this method, together with the exagger-
ated Fowler position, after suitable surgical procedure, has
converted suppurative peritonitis from one of the most fatal
diseases to one with a comparatively low mortality rate. In
December last Dr. Stuart McGuire had used it in eighteen
cases with but one death. Much the same results are being
obtained by numerous surgeons throughout the country.

X. C. MEDICAL SOCIETY. 751

VEXESECTIOX: ITS IXDICATIOXS AXD USES AS
A THERAPEUTIC AGEXT.

BY W. M. LYDAY, M.D., PENROSE, X. C.

General bloodletting from the general circulation, usually
by opening a vein of considerable size, sometimes by opening
an artery or the abstraction of blood from the capillaries and
smaller vessels of congested or inflamed areas by leeches,
scarification and wet-cupping.

Venesection is a therapeutic measure of the gTeatest utility
in properly selected cases, and, like many another agent of
great usefulness has, by abuse, been caused to fall in unde-
served disrepute.

The present paper will, therefore, chiefly be devoted to
general bleeding. This art, practiced for centuries more or
less universally, has of late years in this country fallen into
disfavor. Much discussion has been raised as to the grounds
for so gTeat a difference.

It has been attributed (1) to the type of disease having
undergone a change: (2) to mere fashion; (3) to a better
knowledge of the nature of disease, teaching us that its pro-
cesses were of a depressing or lowering character which were
to be overcome by the more general use of drugs which con-
trol circulation, as well as of stimulant and support.

The probable cause which contributed most to the change
was that venesection was a universal panacea for all diseases,
especially of those diseases that were characterized by ex-
treme depression, as epidemic cholera, typhoid fever, influ-
enza, malignant dysentery. In such diseases if antiphlogistic
measures were adopted they proved failures and taught phy-
sicians that bloodletting was not the universal panacea it
was supposed to be. By degrees it ceased to be practiced as
it used to be.

A new generation which Iniew not of the past has sprung
up and, as in all reactionary movements, the practice has
almost ceased to be a therapeutic measure. It is almost that

T52 FIFTY-FIFTH ANNUAL SESSION

in either extreme there is an evil and that we may have re-
course in certain eases to abstraction of blood with great
benefit, which formerly led to its abuse.

It will be well to consider the subject at some length and
under the following heads:

1. The effect of moderate losses of blood on the healtu ,
economy.

2. The value of bleeding as a remedy in disease, with tuc
indications for its employment in various affections.

First, then, we have to consider the effects of moderate
losses of blood upon the healthy economy. Upon this point
we have abundant evidence, for the custom of regularly
bleeding healthy jDcople had reached such a point during
the early part of the past century that in country districts
it became a habit for adults to be bled as regularly as they
went to market. No better testimony regarding the effects
of this practice could be adduced than that of Sir James
Paget, who says, when referring to these customary vene-
sections, that 'T can regard those as a series of venesec-
tions fairly performed for the determination of what is the
influence of the removal of blood up to the point of syncope
upon a comparatively healthy person; I think I can say
surely that not one of these persons suffered harm." To
this might be added other and abundant testimony to the
harmlessness of moderate venesections on the healthy
economy.

The effect of the operation on the blood is interesting, for
after bleeding the fluids of the tissue are rapidly taken into
the blood vessels to restore the diminished volume of the
blood, thus increasing absorption and relieving congestion,
leaving the quantity the same as before, and the quality in
a more dilute form.

Indication and Uses.
Broadly stated it may be said that bleeding is indicated
when there is evidence of marked over-distention, either of
the arterial or of the venous system. In either case the re-

N. C. MEDICAL SOCIETY. 753

suit will be cardiac distention: in the former case of the
left, and in the latter of the right chambers of the heart. In
such conditions general bleeding restores the lost equilibrium
of the vascular system and relieves the heart and the other
parts concerned in the circulation of the blood.

It may in general be said to be diminution of the circu-
latory excitement, relief of congestion, inflammation and
pain ; lessening of nervous irritability, production of muscu-
lar relaxation and the removal of poisons contained in the
blood. When these conditions are associated with a full and
tense pulse, particularly when accompanied by evidence of
pulmonary engorgement and an ovenvorked and failing
right ventrical, by signs of cerebral congestion and venous
stasis.

Pneumonia. — Bloodletting in pneumonia is indicated in
healthy patients suffering from uncomplicated acute sthenic
pneumonia. If they happen to be seen early enough it re-
lieves pain, aborts fever ; and if it doeb not arrest the disease
it certainly appears to lessen its duration. It may also be
called for when there is severe pain and cardiac embarrass-
ment.

Excruciating pain radiating through the chest denotes
involvement of both lungs, and a bad sign during the first
and second stages, is more successfully treated by copious
venesection than by any other remedy.

In intense dyspnoea with profuse, frothy sputa, moist
rales in the uninflamed parts of the lungs, sudden sinking,
drowsiness, coldness of the skin are signs of carbonic acid
poisoning, and great danger of beginning oedema, our best
remedy is free bloodletting.

To illustrate the good effects of venesection I will give a
case: Was called to S. S. 0., whose daughter had recently
died of pneumonia, and found him with excruciating pains
radiating through the chest, great dyspnoea, profuse, frothy
sputa, moipt rales all through both lungs ; pulse 136 ; temper-

754 FIFTY-FIFTH ANNUAL SESSION

ature 104; respiration 38; skin cold; extensive hypersemia
and oedema.

Prognosis. — ^^Vill die within thirty-six hours.

Treatment. — Opened the median basilic vein and bled
until there was a decided impression made on the system,
which required about sixteen ounces. Effect in one hour :
pain and dyspnoea relieved; pulse 120; temperature 102;
respiration 24; skin moist and warm. Next morning —
rested well during the night — temperature normal; pulse
normal; pain gone. Made an uninterrupted recovery with-
out other medication.

Numbness of limbs, slight convulsions, coma, somnolence
are signs of oedema of the brain, and venesection is our most
reliable therapeutic agent.

In the course of pneumonia or pleurisy, when intense
dyspnoea develops with moist rales, serous sputa, feeling of
fullness and compression, causing fear of death, heart beats
visibly, the radial and carotid arteries, extensive hypersemia
and oedema, the danger is imminent unless relieved by blood-
letting to effect.

For threatened apoplexy regular copious venesections will
be our best remedy, not only obviating the tendency to death,
but has saved the patient's life. The treatment of threatened
apoplexy due to hypertrophy of the heart requires prompt
venesection.

PuERPEKAL Convulsions.

This nci-A-e-irymg condition had formerly been viewed
with well-deserved dread, for the reason that it was largely
incurable. In fact, it is within the limitation of exact trutli
to say that there was a time, by no means remote, when what
few cures did occur should properly be credited to dame na-
ture herself rather than to the attending physician.

Though still at sea concerning the real cause of the con-
vulsive seizures, experience has taught us a reliable treat-
ment. Our knowledge of the supposed cause has also im-
proved enough to make it seem that the condition is one of

N. C. MEDICAL SOCIETY. 755

auto-infection, involving either the liver or kidneys, or both,
for both have been found diseased post mortem in these
cases.

The general indications for the preventive treatment in
these cases may, therefore, be said to consist in elimination.
Ill the robust patients copious venesections, followed by
diuretics and aperients.

For the actual convulsion, either before, during or after
labor, there exists the double indication calling for the rapid
elimination of the toxicant ; and this is effected most success-
fully by copious venesection. This is a specially desirable
method in the full-blooded, though also applicable in others.
The object is to relieve blood pressure, produce relaxation
and abstract a certain amount of the toxins from the blood
itself. Bleed to effect sufficient to control circulation.

Acute nephritis, not complicated by pregTiancy, in severely
acute cases of nephritis, active congestion may cause almost
complete suppression of the urine, aching in the back and
loins, an usually pronounced uraemia. Venesection is our
TQOst efficacious means of relieving this condition. It relieves
congestion and depletes the kidneys, and renders the case
more easily and successfully managed.

To illustrate: was called to Mr. P., age forty-two. Had
been sick forty-eight hours. Found temperature 103 1-2,
pulse 120; great dyspnoea; urine very scant, almost complete
suppression, highly albuminous and bloody; pain in back,
loins and severe headache, beginning of general anasarca;
pronounced uraemia.

Treatment. — Copious venesection, hot fomentation from
shoulders to loins, saline purgatives and saline diuretics. In
six hours temperature 100, pulse 80; skin moist; head re-
lieved, l^ext morning symptoms all relieved, free flow of
urine. Made an uninterrupted recovery without further
treatment.

I believe that one of the principal reasons why bloodletting
is not more commonly employed is owing to the lack of actual

756 FIFTY-FIFTH ANNUAL, SESSION

experience among teachers and the enormous amount of medi-
cal literature which is published against the employment of
this most useful and certain remedy in suitable cases.

I believe firmly, and such has been my personal experi-
ence, that nothing can take the place of bloodletting at the
commencement of nearly all inflammatory affections in
sthenic, plethoric individuals. In pleuro-pneumonia it is
especially indicated.

I hope that within the next few years there will be found
many more medical men carrying lancets, both clean and
sharp, ready for emergencies.

]S^. C. MEDICAL SOCIETY. 757

THERAPEUTICS AN ART.

BY W. H. BOONE, M,D., MOBBISVILLE, N. C.

^0 other department of medical science is more important
than that of therapeutics. It not only offers a correction for
pathological phenomena but a restoration from morbid an-
atomy. It maintains physiological function and makes the
execution of hygienic measures possible. The excuse offered
for presenting this paper, therefore, is to accuse the profes-
sion of therapeutic inefficiency, and to discuss lines of im-
provement.

In the rapid progress of the science of medicine during
the last few decades therapy has not kept pace with other
branches. There was a time in medical history, however,
when it held first place, and a medical adept meant a thera-
peutic expert ; but now it rather means a skillful pathologist,
diagnostician, surgeon or some other necessary appendage
to what should be the real branch. It is true that specifics
have been discovered, certain seimms proven to have wonder-
ful antitoxic and immunizing power, and many drugs puri-
fied and standardized, all of which proclaim advancement;
but because of wide physiological variations and very wide
pathological deviations, coupled often with unreliable drugs,
it follows that therapy is an art requiring skillful adaptation,
and can not be reduced to an exact science of mathematical
quantities.

The reduction to correct exactness of the principles of
other branches in the field of medicine has caused the pro-
fession to a certain degree to lose faith in the efficacy of
drugs to accomplish definite results, and is therefore timid
in its administration and seeks to dodge by throwing the re-
sponsibility of all failures upon the Lord, at the same time
assuming credit for all the Lord's achievements in spite of
his interference.

The physician is like a soldier who meets the enemy,
shoots at random and hope? for victory. The gun is all right,

758 FIFTY-FIFTH ANjSTUAL SESSION

the enemy is in view, but he is not an artistic marksman and
looks in faith to Mars, the God of War, rather than his gun
for success. Nature, the doctor's God, has great compassion
both for the doctor and his patient; covering the mistakes
of the one and healing the ills of the other, in spite of the
drugs shot at random to the contrary. It is a cause for pro-
fessional shame that we abuse tlie goodness of this amicable
friend by being careless, indifferent and skeptical; careless
in looking for the actual cause of physiological distraction,
indifferent to prescribing directly and definitely to the re-
moval of such distraction, and skeptical as to results to be
obtained by drugs other than palliative in correcting path-
ological processes and restoring normal function.

To substantiate this accusation I submit as testimony the
prescription files of any drug store in North Carolina ; I sub-
mit the lists of any proprietary drug-mixing house in Amer-
ica; I submit the bewildering therapeutic opinions of any
representative medical assembly on record. The submission
of further testimony is considered unnecessary accumulation;
and we ask you first to critically inspect the prescription file.
Here you will find chemical incompatibles, physiological an-
tagonists, and a greater number you may class in the shotgun
variety ; the first shows a lack of the chemical knowledge of
drugs, the second proves a deficient understanding of their
physiological action, and the third asserts both a diagnostic
incapacity and a therapeutic inability. The manufacturing-
pharmacists or drug-mixing people are both a blessing and a
curse to the profession. A blessing in that they manufacture
from nature's crude storehouse clean, pure extracts, etc., in-
dispensable in modern therapy ; but a curse in that they take
the initiative in compounding and mixing formulae and urg-
ing their use by the profession, claiming practical merit that
is only theoretical.

They advertise their stuff" like patent medicine concerns,
and seduce the therapeutic artist to befuddle himself with
quackery, to desist from individual experimentation and ob-
sen'ation and to become a rusty scale upon tlie polished art.

N. C. MEDICAL SOCIETY. 759

The therapeutic opinions of a representative body of phy-
sicians like this which I submit, without much comment, is
alone sufficient evidence to warrant the case, for we are all
agreed on bacteriology, chemistry, pathology, etc., almost ab-
solutely; but how many of us can be found to agree on any
one point touching therapy ?

Gentlemen, have you ever thought what an easy thing it is
to i^our a decoction into the belly of a fellow, who is racked
with pain, distressed with nausea or prostrate with exhaus-
tion ? He appeals to a physician, who in the goodness of his
heart yearns to appease the anguish of both mind and body;
or it may be, to air his own medical alertness, gives a dose,
to be doing something, that satisfies the anxious friends, while
the doctor looks the look of confidence and awaits a result in
hope, conscious of having imperfectly fulfilled the mission
for which he was summoned. The surgeon the physician
looks upon as a sort of superior, with a steady nerve, a dex-
trous hand, and unqualified diagnostic ability, capable of
bearing responsibility and of assuming charge of complex
maladies, such as therapeutic indefiniteness has failed to
relieve.

It is a Godsend that we have the surgeon among us, and
we hail him with honor and brotherly love. It is because of
the recognized success of surgery and therapeutic inaccuracy
that the young doctor, zealous for honor and recognitiou,
manifests a thirst for gore at the edge of his scalpel. Let us
glory in the steady inarch of surgery and the life-saving
methods it offers, but let us not lose faith in drugs — for what
the instrument case is to the surgeon the medicine case is to
the physician — only more so. In my humble estimation the
doctor who gathers evidence through careful examination
passes judgment upon the pathology existing and prescribes
with simple definiteness to combat the malady, is the greatest
master in the field of medicine. This master is more of an
ideal than a reality, a mental picture of a possibility, a stand-
ard of efficiency to be sought after.

An optimistic view reveals a brighter day for medicine

Y60 FIFTY-FIFTH ANNUAL SESSION

"when the pendulum of professional enthusiasm ticks the ex-
treme in surgery and swings back to the art of therapy.

God made man, He made the disease-producing microbe
that infects him, and He likewise stored in nature the remedy
for his restoration. It is the task of the physician, therefore,
to discover and prescribe remedies that will successfully com-
bat the ailments of mankind. In the light of modern re-
search aided by chemical and physiological laboratories, to-
gether Avith imlimited clinical material, the opportunity is
afforded the physician to discriminate in the selection of
remedies and to ascertain their uses and limitations. Having
attained this ability, and also having skill to judge a distinct
indication for their use, constitutes the art of therapy. First
to discriminate in the selection of remedies is very important;
there are so many new drugs upon the market to-day that it is
impossible to test them all, notwithstanding there are physi-
cians Avho pride themselves upon prescribing every new drug,
in order to show themselves progressive. They have a lot of
remedies, especially new remedies, for every disease. They
have not yet, as some one has said, developed to the point of
one drug for several diseases. It is necessary, however, to
remember that while we have average data for nearly every-
thing connected with the human being, we have to treat every
patient individually. Therefore, while it is wise to select
and depend upon a few drugs, knowing well their good and
bad effects, yet it is expedient to have a well-selected reserve
for irregularities and idiosyncrasies.

With repect to the use of drugs we aa ill class them as symp-
tomatic and causal. While it is very necessary to relieve a
symptom that is oudaugoriug life, sueli as, for instance, alle-
viation of high fever, the soothing of distracted nerves, the
stimulation of vital centers in case of depression, and the
supplying of fluid to the heart after hemorrhage, yet it is poor
therapy to prescribe promiscuously for every symptom that
may arise. To prescribe for every symptom may count well
with the laity who, ]")robab]y, are induced to think the doctor
is straining liis ability in the patient's behalf and, by his per-

N. C. MEDICAL SOCIETY. 7G1

sistent energy, gain laurels that are sure to fade sooner or
later, and praise, that to him, with his disappointed results,
is as sounding brass and a tinkling cymbal. It is to be re-
membered that the symptoms are not the disease and that
when the cause is removed the symptoms disappear.

The removal of the cause being a complex task requires
the greatest skill, for each organ is in close sympathy with
every other one, and due regard must be paid them all. To
treat the liver independent of the rest of the body will fail of
success, because the stomach, the bowels, the kidneys and
other organs are functionally disturbed by its derangement.

An ideal therapeutist then would combine the use of symp-
tomatic and causal remedies, not forgetting in his zeal to
cure the disease, the welfare of the patient. The limitations
of drugs in the art of therapy are determined by their phy-
siological action in individual, pathological conditions. It
must be remembered that the tabulated physiological effects
of drugs in a large measure have been worked out on the
lower animals and man in health. Especially is this true of
the newer drugs. In view of this fact, it is not wise to expect
results in diseased conditions by using average doses. There
is but one way to know the effects of drugs and to expect
Tesults from their administration in a diseased individual,
and that is by observation. The habit of prescribing the
•average dose as suggested by standard works of Materia
Medica and Therapeutics, is largely accountable for the dia-
■appointing results which have fostered a skeptical sentiment
regarding therapy. If a drug has the power to produce a
certain effect and it fails when administered to do so and no
untoward symptom arises, it is folly indeed to abandon it to
try another ; why not push it until the desired end is attained,
observing closely for ill manifestations, remembering that —
" Full many a shaft with purpose sent,
Finds mark the archer little meant. "

An illustration of this point is to be had from the giving of
Tiratrum viride in a case of puerperal convulsions. Follow-
ing the advice of a brother practitioner, we endeavored to re-
duce the pulse beat from 140 to 70 per min., being assured

^162 FIFTY-FIl^rH ANNUAL SESSION

that the convulsions would cease, 30 drops of the tincture for
several successive doses every thirty minutes were required.
Pulse was softened and reduced and kept so hy an occasional
addition of 20 drops; convulsions ceased and the patient re-
covered. We have had surprisingly good results from the
tinct. of aconite in the onset of pneumonia, by giving it with
a free hand to relieve a lung from congestion and engorge-
ment by decreasing arterial resistance and cardiac force,-
thereby preventing hemorrhage into the air cells and conse-
quent blood clot or consolidation. In several cases we have
seen acute attacks of appendicitis relieved absolutely by the
administration of four oz. of sweet oil every four hours, the
idea being to lubricate the intestinal tract from os to anus
and thereby relieve the strangulation.

" Diseases desperate grown
By desperate appliances are relieved
Or not at all."

While cases in extremis require radical measures, conser-
vatism is the best ]iolicy, for often simple remedies, in a
simple way, for simple ailments, are better than a bombard-
ment with more powerful drugs ; but such simple simplicity"
as letting nature take her course when her course is bad, as it
is in every diseased condition, will often assign a curable
patient to an apartment beneath the sod.

Let it not be forgotten that mankind is both spiritual and
material. That many are much more spiritual than mate-
rial ; therefore, to complete the art of therapy, the mental man
must not be overlooked while treating the physical man.
The balm of suggestion, the oil of confidence and the soothing
of hopeful expectation are indispensable aids and can not be
ignored.

We need not less of science but more of art. To know how
to cure is the doctor's most valuable asset. Many funerals
bring idleness into his office and tie crepe upon the door of
his reputation ; besides —
" It is an awful thing, to see a human soul take flight,

And leave but a pile of mother clay, to the physician, his respects to*
pay."

N. C. MEDICAL, SOCIETY. 763

HYDEASTIS TEEATMEIs^T OF BKIGHT'S DISEASE.

BY FRANCIS DUFFY, M.D., NEW BERN, N C.

For at least twenty years I have been using hydrastis
canadensis in cases of Bright's disease of the kidney and in
some other diseases of the kidney or urinary tract, as the
presence of albumin in the urine has been the signal or indi-
cation in a general way for the use of that remedy. The use
of this remedy was not original with me so far as giving it a
place in the catalogue of drugs used in Bright's disease is
concerned, for in some of the old works on materia medica
references to the drug may be seen in connection with Bright's
disease, but only as in a catalogue of remedies that have been
used in a given disease. The longer the list the more certain
that no effectual remedy or satisfactory treatment has been
found, so when I began to use this remedy it was only as an
adjunct from which a possible advantage might be obtained.
After a while I began to think it was useful in these cases
and sought to know how much I might give with advantage
and without danger. The preparation used was generally a
fluid extract, preferably the alcoholic but often the aqueous.
The w^hite preparation I did not use, as that does not repre-
sent the drug. I soon began to give one drachm doses three
or four times daily, having as an experiment taken two
drachms myself wdth no unpleasant result. I would some-
times use as much as six drachms daily in bad cases.

My brother, Dr. Chas. Duffy, with whom I have been sc
long associated in the same office, has had some favorable
results with the use of the remedy in albuminuric cases, and
from him I got the valuable suggestion to use smaller and
more frequent doses. My experiences have been very favor-
able in this connection, as I shall attempt to show by specific
references to cases.

I have been asked repeatedly to write on this subject, but
have hesitated to do so, largely because I had kept no accn-

764

FIFTY-FIFTH ANNUAL SESSION

rate data of cases, and further because claims of marked
benefit or cures of Bright's disease bj any medicine would be
startling if they received respectful attention, and every state-
ment would be challenged.

To meet these challenges or inquiries, I am well aware that
the most accurate physical and laboratory examinations should
be made and the most discriminating judgment used to ascer-
tain as far as possible to what the albuminuria is ascribable
in any given case which has been cured or benefited by the
use of hydrastis.

I regret that as for the most of my experiences these de-
tails are lacking, and consequently this paper very unsatis-
factory to myself.

Of the cases occurring in the earlier years of my expe-
rience, I can only say from memory that a number of cases
of patients having albuminuria and other cases of kidney
disease (in one case convulsions), apparently recovered under
treatment by hydrastis. Some of these cases were dropsical.
In some the duration of treatment was only a few weeks, in
others requiring several years.

One case; male; age, 35 years; occupation, merchant, was
under treatment over ten years. He bought pint bottles of
fluid extract of hydrastis at a time, and he estimates that he
has taken from half a pint to a pint a month, with occasional
intermissions.

I examined this man for life insurance, and having tested
his urine, passed favorably upon his application, and a policy
was issued. About a month later I examined him for another
company and found albumin in his urine, which condition
was constant under repeated tests. He was then given the
hydrastis treatment, but he continued in a run down, weak
condition for at least a year, with constant albuminuria.
Then there was complete absence of albumin, but with occa-
sional recurrence as treatment was discontinued. During the
last five years or more I have not found albumin in his urine.
A test at the time of this writing shows none and he appears
to be entirely well. He has had only the hydrastis treatment.

N. C. MEDICAL SOCIETY. 765

except as a simple purgative might be required or quinine for
malaria.

Barthalow places livdrastis second to the cinchona prepara-
tions as an antiperiodic, but I have known malaria chills to
occur while patients were regularly taking hydrastis, and
Avhile I do not think much of it as an antimalarial remedy, I
have used it in cases of hemorrhagic fever, in some cases and
in some stages of which it has seemed to be of value.

In my first experiences I used a number of remedies, such
as Basham's mixture or some other preparation of iron,
iodide of potash, digitalis, lithia, etc., plus hydrastis. Xow
I use hydrastis only, except perhaps some symptomatic rem-
edy as a saline purgative or quinine for malaria or possibly
iron for ansemia.

I use from twenty minims to thirty, usually every three
hours, sometimes every two hours, sometimes at interv^als of
four hours, exclusive of the hours of sleep. Hygenic rules of
course to be observed. Undue exposures and chilling of the
surface to be avoided. Overexertion always increases the
albumin. As a rule, no particular diet is enforced except to
avoid overeating and especially of meats. Gluttony, espe-
cially as to albuminoids, is much more causative of the dis-
ease than excessive alcoholic drinking, which, however, is to
be avoided, and which stands in causative relation to chronic
intestinal nephritis. I have never gotten much satisfaction
from milk diet as a treatment, but in moderation, it is quite
advisable as a food to those with whom it agrees.

The copious drinking of mineral waters in connection with
the hydrastis treatment appears to be exciting and harmful to
the kidneys in some eases, one of which will be given. But
T do not mean to deny the usefulness of minerals in a
general way in connection with Bright's disease.

About the first effect of the hydrastis treatment is to de-
crease the excessive volume of urine in that class of cases in
which this symptom prevails. It is well to find out by
measure what quantity is secreted in the twenty-four hours
before giving the hydrastis, then as it is given the quantity

766 FIFTY-FIFTH ANNUAL SESSION

of urine will usually begin to diminish, day by day, until it
reaches the normal amount. I am not aware that the quan-
tity of urine can be reduced by hydrastis below the normal
quantity.

At first there may be the same relative quantity of albumin,
the absolute amount being diminished in proportion to the
reduction of the volume of the urine. Then in many cases,
after a long or shorter time, all symptoms disappear, some-
times to return, frequently not so.

I do not wish to be too enthusiastic about this treatment,
or to be understood as saying all cases will recover thereby.
Of course such is not the case.

I am now treating several patients with Bright's disease
who are but little benefited by the treatment. They are cases
■of long standing, long undiscovered or long neglected. Some
I seldom see and have but little knowledge of their treat-
ment or condition. One of these now, confined to bed, I
warned years ago, but he was indifferent until oedema and
■other symptoms compelled him to seek treatment. Hydrastis
then seemed to benefit him, but in active employment and
disposed to exert himself to the utmost, he was finally over-
come, having besides general anasarca cedema of the lungs,
with great difficulty of breathing, hypertrophic heart, with
abnormal blood pressure and arterial sclerosis, was somnolent
and had hallucinations.

For a time hydrastis was discontinued in this case and
remedies used for the reduction of dropsy and relief of ex-
cessive blood pressure. This patient continues to live, is
more comfortable and even hopeful, but it is only a question
of time when he must succumb. He is now on a mixed treat-
ment of hydrastis, calcium chloride and nux vomica, with
saline laxatives as required.

Another case now under my care is one of such compli-
cations as to make it uncertain that the kidney trouble is
entitled to first place in the morbid curriculum. A lady
sixty years of age had been confined to her room and most of

N. C. MEDICAL SOCIETY. 767

the time in bed a year before I was called to sec her. First
examination of urine showed presence of a little albumin, for
which no special treatment was offered. After several weeks
the albumin was in greater quantity and microscope showed
granular and hyaline casts. Hydrastis treatment was given
and within a week every trace of albumin had disappeared.
]\Jieroscope showed no cast present. Then the hydrastis was
reduced to fifteen drops three times daily. After a few days
the bare trace of albumin was again present in the urine.
Under this meager dosage the urine in a few days more
showed an increased quantity of albumin. Then fluid ex-
tract of hydrastis was ordered in half-drachm doses every
three hours, but the patient was feeble and nauseated and
failed to take the desired quantity. From day to day ex-
aminations of the urine have been made, but at no time has
the urine been entirely free from albumin, though at the time
of this wi'iting Heller's test discovered but a bare trace. I
am hopeful of a complete disappearance. The ISTational Dis-
pensatory states that in medicinal amounts, hydrastis has but
little effect ujjon the vital functions, but in large amounts is
exceedingly poisonous, and again explains that the dose of the
fluid extract is from 5 to 10 minims. Under the separate
description of the fluid extract larger doses are stated, but
authoritative books do not give the dose the same, and in
some places the tincture is rated at the same dose as the fluid
extract. The entire drug contains hydrastine, berberine.
canadin, and a volatile oil.

It seems to be an established fact that death may be caused
by the drug, hydrastine being a dangerous constituent. I
have prescribed that alkaloid, keeping within the narrow
limits of the established dose, of from one-quarter to one-half
grain. I can not say what results followed, or that a given
result was on account of it. After having taken two drachm
doses of the fluid extract myself experimentally and having
no discomfort from it, I did not hesitate to give from a half
drachm to a drachm to others, yet T recently knew of a pa-

768 FIFTY-FIFTH ANNUAL SESSION

tient who I think was mildly poisoned with it, the firet
symptom being an intolerance of the drug, which caused
vomiting of the doses. Exceptionally patients have a disgust
for the drug, saying it is the worst on earth. If I can not
overcome that, I regard the fact as unfavorable to the patient
and likely to affect the prognosis unfavorably. The acknowl-
edged therapeutic application of this remedy is for mucous
membranes. The epithelium becomes soaked in it, when
enough is applied, and the taste and stain are not easily eradi-
cated. That it is useful in such cases is common knowledge
set forth in any therapeutic work. As the alkaloids are elimi-
nated by the kidneys largely unchanged, it would seem ra-
tional that those organs might be beneficially influenced by
the application. My own experience as related in part, how-
ever imperfectly, assures me that such is the case, but I have
not found in literature that the profession is aware of that
use of the drug. Taken as an example, the text-books on the
practice of medicine, materia medica and therapeutics in the
Johns Hopkins School of Medicine, Baltimore, do not men-
tion the remedy in this connection.

The following case seems to illustrate the possible harm-
fulness of too much treatment. An elderly gentleman came
to my office complaining of symptoms which I thought might
be referable to his kidneys. On examination of his urine my
suspicions were confirmed. He was in consternation when
informed of his trouble. He was placed on the usual hy-
drastis treatment ; no other drug or medicinal agent was used.
He slowly improved until I assured him that there was no
longer a trace of albumin in his urine. The drug was advised
in diminished quantity and I saw no more of him for a while.
Then he returned not feeling so well, and an examination
showed a return of albumin. Investigation discovered no
cause for the relapse, except that he had tried to make as-
surance doubly sure by supplementing my treatment with
copious draughts of a mineral water, which he had ordered
without my knowledge. I directed him to discontinue the
mineral water and stick to the hydrastis. In a short time

N. C. MEDICAL SOCIETY. 769

albumin disappeared and has not, to my knowledge, returned.
I have made several examinations of his urine.

One more will close my report of cases.

On the 9th day of April, 1908, a man came to my office for
treatment. He is aged forty-nine years, six feet in height
and weighs three hundred and thirty pounds. Breathing was
labored and his legs very oedematous. Examination of urine
showed copious albumin. Microscope showed hyaline and
granular casts. Heart appeared to be normal. No stiifness
of the arteries. 'No fever or other acute symptoms. He was
placed on the hydrastis treatment exclusively, except that
some ipecac was furnished him in case he could not otherwise
control his inordinate appetite. He was especially instructed
as to hygiene and strenuously advised to eat but little, espe-
cially of meats. On the 14th of April he returned. He re-
ported that he had carried out instructions. Albumin and
casts had entirely disappeared from the urine ; oedema about
all gone; looking better and quite cheerful. Examined
several times since the second visit; he shows no sign of
trouble except his obesity. About six months ago this man
had what appeared to be kidney colic. I examined his urine
at that time and a number of times afterward. There was
no albuminuria then.

I know full well the imperfection of the data herein given.
It is with diffidence that I give them to the medical profes-
sion, with the hope that enough interest may be excited in this
subject to cause clinicians with hospital and laboratory facili-
ties and abundant material to make a discriminating study of
the remedy, hydrastis, in its relation and application to kid-
ney diseases and to give it the proper value. Meantime, to
my fellow-practitioners of the country and small towns, I say,
try it for yourselves, with such advantages as you have.

l^othing will reconstruct a degenerated organ, but it is not
too optimistic to say that a vital organ capable of function-
ating may be amenable to some assistance and the beginnings
•of morbid processes may be effectually arrested.

770 FIFTY-FIFTH ANXUAL SESSIO^T

There is another class of eases involving the kidney, in
which I have only made one trial of this remedy, namely:
the toxaemics of pregnancy accompanied with dropsy and al-
buminnria. This case came under my observation about the
first of March of 1908. Examination of the urine showed
no albumin at that time. Subsequent examinations gave the
same result, but about the first of April the husband lirought
a specimen of urine and made the statement that his wife was
becoming (Edematous, had headaches and numerous specks be-
fore the eyes. Examination of the urine revealed albumin.
Microscope showed no casts. The patient was advised to
avoid eating meats, to take milk and vegetable diet, but in all
diet to be abstemious. Patient was given saline purgatives
and diuretics. Small doses of protiodide of mercury thrice
daily. Mixed bromides were given to control headaches and
nervousness. Several reports and examinations of urine rang-
ing through a period of two weeks showed no substantial im-
provement. Then all medicinal treatment was dropped, ex-
cept fluid extract of hj'drastis, half drachm doses every four
hours and mixed bromides as required. At the end of one
week there was little change, but slight diminution of albu-
min in the urine. Treatment was continued. The patient
living in the country was not heard from again until the 30th
of April, when she was delivered of a child with no untoward
event. On questioning her she told me that the dropsical
swelling had disappeared as well as the headache and spots
before her eyes before the time of her delivery. I had no
other opportunity to examine the urine.

The very high cost of this remedy is a serious drawback to
its use in many cases. The plant is said to be becoming
scarcer and scarcer, yet its habitat extends over a large section
of country. Up to the present it seems to be gathered as it
grows wild and its area constantly encroached upon. It may
be that its usefulness and very high price may lead to its
successful cultivation.

N. C. MEDICAL SOCIETY. 771

CASE OF MYXCEDEMA CLOSELY SIMULATING
BRIGHT'S DISEASE; WITH A A^OTE OX THE
TREATMENT OF REXAL ALBUMIXURIA BY
THE ADMIXISTRATIOX OF HYDRASTIS CAXA-
DEXSIS.

BY RICHARD N. DUFFY, M.D., NEW BERN, X. C.

The following case is of interest for two reasons: first, in
showing the effect of hydrastis on renal albuminuria, and sec-
ond, in showing how easily one may be misled in the differen-
tiation of chronic nephritis from myxoedema.

Mrs. M., a white woman, 53 years old and a native Xorth
Carolinian, was first seen by me on December 31, 1907, com-
plaining of ''swelling of body, weakness," etc. She gave the
following history:

She is a wadow and has had five children and two miscar-
riag-es. Her father and mother both died of "paralysis."
She was delicate as a girl. Had chlorosis at nineteen years,
"typhoid" fever when her first child was born, pneumonia
nine years ago. She has had a great many chills and fevers.
Her appetite and digestion are usually good and her bowels
regular. There has been no evidence of chronic pulmonary
involvement. She has had some shortness of breath for about
a year. Has had to get up about three times every night to
urinate for the past year or two. Her urine has at times
been cloudy. She has never noticed any blood or any burn-
ing or pain on urination.

Her menses were regular and painless until June, 1907.
At this time the flow lasted 28 days. It again appeared
slightly on July 1st. The latter part of July she had two
severe hemorrhages. She passed large clots and became al-
most exsanguinated. About this time her abdomen began to
swell. She has had swelling of her hands, feet and eyelids
for about three years. She began to grow stout about three
years ago and has gained 43 pounds in this time.

ii2i FIFTY-FIFTH ANNUAL SESSION

When her abdomen began to swell after the hemorrhages
last Slimmer she went to Dr. Stokes's Sanitorium in Salisbury
and was operated upon, a pan-hysterectomy being done. Be-
fore the operation she felt "tired out," as she expresses it, all
the time. Immediately after the operation she was very
much better, but has since grown worse.

She now feels tired out most of the time. Wakes up tired
in the morning. Her appetite and digestion have remained
fairly good and her bowels regular. She sleeps fairly well,
but often in the early part of the morning wakes up with
choking sensations and feels as if she were going to die. Her
lids are sometimes so swollen that she can hardly see. She
tires very easily and sometimes has dizzy sensations. Her
throat often feels full and tongue thick, and it seems difficult
to talk. Her memory has become defective and she is sus-
picious and irritable. There has been some numbness in the
left leg.

On examination it was noted that the patient had a stupid,
"toad-like" look. The face showed a pasty pallor. Eye lids
were oedematous and translucent even. The whole face
seemed swollen. The mouth was large and lips and tongue
thick. The tongue was protruded in the mid line readily
and was not tremulous. Eyes were normal in appearance
and movements except for their dull and stupid look. It was
noted that the patient was extremely garrulous. Iler pulse
was 29 to the quarter, regular in force and rhythm and of
good volume. The tension was only slightly above normal
and the vessel wall just palpable. Her hands were dry and
skin dry and harsh all over body. It felt also distinctly
thicker than normal. The thyroid gland was not palpable.
No tremor of hands and no ataxia. ISTo signs of paralysis.
There was no general glandular enlargement. The nutrition
of her hair was defective.

The heart and lungs showed no abnormality.

The abdomen was full. Panniculus well marked and skin
thick and harsh. A well healed scar of operative wound was

N. C. MEDICAL SOCIETY. 773

seen in the mid line below the umbilicus. jSTo masses could
be palpated in abdomen and there was no tenderness. Neither
kidney nor spleen were palpable.

Skin over shins and feet was observed to pit slightly on
pressure. Skin elsewhere on body did not pit on pressure,
though having an oedematous appearance. The ''knee kicks"
were active. Babinski's sign was not present.

Examination of the urine revealed a heavy ring of albimiin
with Heller's test (at least | of 1 per cent of albumin). The
urine was slightly acid, yellow in color, clear, specific gravity,
1.030 ; no sediment. The eentrifugalized specimen showed
epithelial cells, white blood corpuscles and unmeroces hyaline,
finely granular and epithelial casts.

My first impression of the case was that it was one of
myxcedema, but after an examination of the urine, the diag-
nosis of chronic nephritis was made. I failed to state that
the urine of this case had been examined repeatedly some
time previously by several other men suspecting Bright's dis-
ease without finding a trace of albumin.

The patient was put on a limited diet, advised to take a
daily tepid bath, to keep her bowels open, and take a moderate
amount of outdoor exercise. She was given Blaud's pills.
grs. 5, three times daily after meals, and strychnia, gr, 1/-1:0
three times daily before meals.

There was only slight improvement under this treatment,
and on January 17th, after having heard of my father's and
uncle's (Drs. Charles and Frank Duffy's) experience with
hydrastis in the treatment of various forms of Bright's disease,
she was started on fl. ext. hydrastis gtts. 20 every two hours.
On January 25th it was noted that her condition was some-
what better. Her nights were much better, and she was not
so tired out. There was, however, a great tendency to drow-
siness. Her general appearance remained about the same.
The hydrastis was increased to gtts. 30 every two hours.

On January 28th the albumin had decreased to one-fourth
the original amount. The specific gravity of the urine was

774 PIFTY-FIFTH ANNUAL SESSION

1.010. On February 5th the albumin was reduced to one-
eighth the original amount. The patient's symptoms were
somewhat improved, though her appearance remained about
the same. The hydrastis was now given in 30 gtt. doses
every three hours.

The patient continued about the same. The albumin grad-
ually decreased in amount until February 27th, when she
complained of much nausea, severe vomiting and dizziness.
This Avas attributed to uraemia, but an examination of the
urine at this time showed marked improvement and the pa-
tient complained bitterly of the hydrastis. This was stopped
and condition soon cleared up after purgation, sweating, etc.

The hydrastis was not given again until the nausea had
been absent for several days, and was then given in teaspoon-
f ul doses after meals. Some cases do not take hydrastis well.
There seems to be a cumulative action which finally ends in
severe nausea and vomiting. This patient, for several days
before her attack, complained bitterly of the constant nau-
seating taste of the hydrastis, and when she first began vomit-
ing she said it seemed to her as if she were vomiting pure
hydrastis. Very large single doses may be borne with im-
punity, but constantly repeated doses are in some cases apt to
have a poisonous effect. It seemed in this case, after recon-
sidering the facts, that her vomiting was due to the action of
the hydrastis and not to ura-mia, as was first thought. Since
this time she has been cautioned to stop the hydrastis imme-
diately as soon as she began to be disturbed by its nauseating
taste, and since following this plan she has had no further
trouble.

The patient has continued the liydrastis up to the present
date with steady improvement in the condition of the urine.
Notwithstanding this, her disability has constantly progressed
and her a]ipearanee has not been improved as one would ex-
pect it to be considering the marked improvement in her uri-
nary condition.

On May 23d an examination of her urine showed only a
very slight trace of albumin and only three hyaline casts were

X. C. MEDICAL SOCIETY. 775

found in the centrifugalized specimen. Thinking it most
peculiar that, if the case were one of chronic nephritis pure
and simple, there was not more marked improvement in the
patient's general appearance and symptoms, considering the
very marked improvement in the urinary condition, my origi-
nal diagnosis of myxojdema was reverted to and the patient
given one grain of thyroid extract after each meal. There
has since been marked improvement. In about three weeks
time on this small dose the patient lost six pounds in weight.
Her appearance became much more animated and intelligent,
and her strength rapidly increased. The dose of the thyroid
extract has now been increased to gr. 2 three times daily after
meals and will be gradually increased to gi*s. 10 or 15.

Her improvement continues and the case evidently seems to
be one of those cases of myxoedema which are complicated by
renal involvement. The marked effect of the hydrastis in
lessening the amount of the albumin and the number of the
casts is especially noteworthy.

[In a later note the author of the above says: "Since the
paper Avas written the patient has practically entirely recov-
ered under the thyroid extract and fl. ext. hydrastis. She has
lost 33 pounds in weight and is now a bright, vivacious wo-
man, able to attend intelligently to her business and other
affairs ; whereas, only a little over a month ago she was a
stupid, toad-like creature and a great care to her family.
Both the albumin and the casts have disappeared entirely from
her urine." — Ed.]

776 FIFTY-FIFTH ANNUAL. SESSION

ADRENALIN CHLORIDE : ITS USES IN MEDICINE.

BY C. O. ABERNETHY, B.S., M.D., RALEIGH, N. C.

The term adrenalin chloride is used in this paper to desig-
nate tJie physiological activity of the suprarenal glands, be-
cause this preparation of the drug is most used. There are
various other preparations on the market which have the same
physiological action.

Adrenalin chloride when applied directly to a raw surface
or mucous membrane causes a blanching of the tissue by its
constricting effect upon the involuntary muscle fibers which
are under control of the sympathetic nervous system. The
muscles which do not contain sympathetic fibers are not sup-
posed to be acted upon. Hemorrhage from an exposed blood
vessel is controlled by the application of adrenalin chloride,
due to its action upon the vasoconstrictor mechanism and by
its slight increase in the coagulability of the blood. Con-
tinued application under pressure is necessary for the best
results in this respect.

The most pronounced physiological action of adrenalin
chloride is its effect upon the circulatory system after absorp-
tion or when transfused directly into the blood current. The
rate of the heart's action is at first decreased by stimulation
of the vagus, but later increased by direct stimulation of the
vasomotor mechanism of the heart muscle. The vasocon-
stricting action causes a contraction of all blood vessels, but
especially the arteries and arterioles ; thus the blood supply
to all mucous membranes under control of the vasomotor sys-
tem is lessened. The combined action on the heart and con-
striction of the arteries causes a very marked increase in
blood pressure, which is most marked after intravenous in-
jection of the drug. This high blood pressure causes an in-
crease in the watery elements of the urine.

k. c. medical society. 777

Local Use.

Adrenalin chloride is used very extensively in controlling
hemorrhage where the drug can be locally applied. One of
the best remedies we have in controlling epistaxis is to pack
the nasal cavities with gauze saturated with a 1/1000 solution
of adrenalin chloride. It is also used to control hemorrhage
after operations in the throat and nose ; and it can be used,
and is an excellent remedy, in any bleeding where the part is
locally accessible. It has the advantage of other local hemos-
tats in that it leaves a clean surface. To be of the most ser-
vice in these cases the drug must be in contact with the bleed-
ing surface during a continuous period of time ; that is, ap-
plied on a pledget of cotton, and best, under slight pressure.

In acute coryza, rhinitis, pharyngitis, tonsilitis and other
affections of the air passages adrenalin chloride in the form
of a spray has proven very efficacious. Its strength as used
varies from 1/2,000 to 1/10,000. In inflammation or pus
in the antrium or frontal sinus adrenalin chloride spray has
proven very beneficial in my hands. The action is by con-
stricting the tissue at the openings of these cavities, thereby
allowing free drainage. These cases are often cured, and
when not completely cured are benefited by this treatment.

The use of adrenalin chloride in conjunction with cocaine
in operations on the eye has been very highly recommended.
It prolongs the anesthesia and in addition lessens the amount
of hemorrhage. There is also a tendency to prevent absorp-
tion of cocaine, thereby lessening the danger of poisoning.
It is also used in minor surgery in combination with cocaine.

Use in Contkolling Distant Hemorrhage.
The use of adrenalin chloride in checking hemorrhage in
vessels not accessible to local application, as in the lungs and
intestinal tract, has in its favor the fact that in addition to
constricting the blood vessels it also slightly increases the
coagulability of the blood, but I think the sudden increase in
pressure more than counterbalances the above apparent ad-

T78 FIFTY-FIFTH ANNUAL SESSION

vantages. Its value is again decreased when administered
by the mouth, due to the readiness with which it is decom-
posed in the stomach; thus very little effect is produced in
the intestinal canal. Then in the lungs there is the possi-
bility of not having the vasoconstricting effect, and we get
a dilated vessel with an increase in pressure which would
make the hemorrhage greater; therefore, I think the use of
adrenalin chloride in controlling distant hemorrhage should
be discouraged, as it probably does harm, as may any sub-
stance which increases blood pressure.

Use as a Heart Stimulant.
Adrenalin chloride is being very extensively used now as a
heart stimulant, and it is one of the best in certain conditions.
In collapse from chloroform or ether during surgical opera-
tions an excellent stimulant to tide the patient through the
shock is ten minims of adrenalin chloride given hypodermati-
cally and repeated if necessary. Its advantages are that it
acts very rapidly and powerfully. So in any condition of
shock characterized by low blood pressure, such as chloral
poisoning, etc., adrenalin chloride is the stimulant of choice;
but this drug should be used with care in heart affections
where the blood pressure is not lowered, or in very old people
or people with calcareous arteries.

Use in Bronchtal Asthma.
Adrenalin chloride in the form of a spray has been used in
treating bronchial asthma and hay fever for many years, but
its use hypodermatically is of very recent date. I wish to
lay especial stress on the hypodermic use of adrenalin chloride
in the treatment of bronchial asthma. I have used it in
many cases with satisfactory results, the most severe spasm
of asthma being almost immediately relieved after the hjpr»-
dermic injection of ten drops of the 1/1000 solution. I use
it in the concentrated form ; however, it can be used either
concentrated or diluted with normal salt solution or sterile
water. I use it in the concentrated form and have seen no

y. C. MEDICAL SOCIETY. 779

•discomfort therefrom. In fact, I believe it to be better on
acconnt of a smaller amount of fluid to inject under the skin.
This dose, if necessary, can be repeated every two or three
hours, but usually the effect of one dose lasts from three to
six hours. I have seen no ill effects from the continuous use
of the drug, it not being- necessary to increase the dose, but
it is claimed that prolonged use will cause a hardening of the
-arteries. The action of this drug on asthma probably throws
some light on the pathology of this disease, as it is hard to
conceive how adrenalin relieves a spasm of the bronchial
tubes, but the action on a turgescence of the mucous mem-
l)rane is easily understood.

Use IX Pleuritic Effusion.

There have been cases reported where adrenalin has been
used in pleuritic effusion. After aspirating the cavity, a so-
lution of adrenalin chloride is injected through the aspirator.
It is also recommended to be used in ascites. The action in
these conditions is not fully understood.

Dangers ix the Use of Adrexalix' Chloride.

The dangers in the use of adrenalin chloride are very few.
Immediately after the administration of the drug the patient
■who has taken it has a tingling sensation and feels nervous
and turns pale, which is caused by the sudden action of the
•drug on the blood vessels, and is soon overcome. This is the
normal action of the drug and should cause no alarm. The
•especial danger in administering adrenalin chloride is the
rupture of an artery, due to the sudden increase in pressure ;
therefore great care should be exercised in giving it to people
•who have any degeneration of the arteries, especially old
people.

'SO fifTy-fifth annual, session

TOXIC CHANGES FKOM PEOLOXGED USE OF
ACETANILID.

BY H, H. KAPP, M.D., VVINSTON-SALEM, N. C.

That chronic poisoning characterized by degenerative
changes in the blood and pronounced physical signs, as con-
gestion of the spleen, liver, and kidneys may result from the
continued ingestion of the anilin derivitives is well known,
as it is also well recognized that acetanilid, one of these pro-
ducts, because of its small cost and its toxicity in excess of
others of this group in common use, renders it particularly
liable to be the offending agent. Acetanilid is the chief ingre-
dient in headache powders so generally dispensed by drug-
gists without prescriptions, as it is in certain secret nostrums
or quack medicines both in use by the rank and file of the pro-
fession, and unfortunately thus introduced by them to the
laity in the form of antikamnia, ammonol, organine, phenal-
gin, bromo-seltzer, salacetin, and different headache powders.
The toxicity of acetanilid in common with the other coal tar
products of the antipyretic group has long been known, and
the serious, if not fatal, results which may follow its incau-
tious use in fevers and debilitating conditions, especially in
the very young and very old, should have in past years been
brought forcibly to the attention of the reckless seeker after
a remedy to reduce temperature or to relieve pain. But the
knowledge of the toxic action of this group, and especially of
acetanilid from its cheapness, has had little effect on the un-
scrupulous, who have found a ready and anxious market for
certain compounds offered as cold nippers, analgesics, etc.
Attempts have been made to overcome the immediate ill ef-
fects of the drug by combining it with small quantities of
eaffein, and the very popular nostrum now — I suppose pretty
well known throughout the civilized world — contains these as
chief ingredients, which also enter into the make-up of nearly

X. C. MEDICAL SOCIETY. 781

all so-called headache powders. For a brief review of the
physiological action of acetanilid and other of the coal tar
antipyretics, we note that first on the :N'ERV0US SYSTEM
they act as a sedative to the sensory side of the spinal cord
and sensory nerves having little or no effect on the motor side.
Second, on the CIRCULATIOISr it tends to depression rather
than stimulation, there being an immediate fall in arterial
pressure with a diminished pulse rate, the heart as well
as the vasomotor system being depressed. Third, on the
BLOOD, after continued use, we find the characteristic
brownish-red or chocolate hue to this fluid, from the presence
of methemoglobin, and disintegrated red blood corpuscles —
and interference with oxidation. Aside from the beautiful
tinting of the red cheeks in the beginning of tuberculosis,
being all the more striking from the anaemic condition of the
surrounding skin, there seems to me nothing so diagnostic in
medicine as the dirty, dingy-looking, cyanotic face of the con-
stant user of bromo-seltzer, antikamnia, or other headache
remedies containing acetanilid or its cousins, antipyrin,
phenacetin, etc. Fourth, on the EESPIRATION no effect
has been produced in moderate doses according to Hare,
though we find it is rather a depressant, large doses producing
death by paralysis of the respiratory center. Fifth, on the
TEMPERATURE ; it lowers normal body temperature and
on fevered temperature it acts as a powerful antipyretic, low-
ering fever by decreasing heat production, through its action
on the corpus striatum, and increasing heat dissipation
through the pores, etc., through its action on the nervous sys-
tem. Sixth, on the KIDITEYS we notice after prolonged
use the excretion becomes dark from the presence of broken
down blood coloring matter, and I have found traces of albu-
min. That the action of acetanilid is more pronounced on
the blood than on any other part of the system is generally
recognized. Consequently its effects on the circulation, res-
piration, temperature, and elimination, are all probably sec-
ondary to the blood changes brought about by too large a dos-

782 FIFTY-FIFTH ANNUAL SESSION

age or by prolonged use. The dose which most eommoidj
produced symptoms were ranged from three to ten grains.

Then, to return to the clinical toxic action of these coal
tar derivatives, I have now under observation a man aged
forty, of splendid physical development, who first consulted
me about his digestion. He was not given to alcohol and but
moderately' to tobacco, getting an abundance of fresh air and
exercise, and having no element in his life unconducive to
well-being, yet he had been unaccountably out of sorts for
the past year or ,two. You were at once struck by the pecu-
liar sallow, dusky hue of his skin, and bluish lips. Exauii-
nation of the chest showed this not to be attributed to any
respiratory or cardiac disability. Inquiry_ elicited the fact
that for two or three years his habit had been to take headache
powders. He had formed the habit of taking them at first
for relief of headache and finally w^hen at all out of sorts.
He had invariably taken one on arising in the morning and
sometimes several (eight or ten) through the day, but often
only two or three. These were a proprietary preparation sold
under the name of a certain doctor's headache powders. The
blood as it stood on the ear showed a decided chocolate hue,
indicating the presence of methemoglobin, hence it was impos-
sible to make the usual test for the hemoglobin estimation.
A blood count was then made and the erythrocytes or red blood
cells were found diminished in number to 3,260,000 per cm.,
showing variation in size and shape, the microcytes and poikil-
ocytes being in abundance. The leucocytes were increased in
number to 9,600 per cmm. The leucocytes being in abund-
ance, the Ehrlich triple stain was used and a differential
count was made. Upon examination polymorphonuclears
were found most abundant, next the large lymphocytes, then
the small lymphocytes, and a few eosinophiles. The blood
examination was made five hours after the only meal of the
day, a lunch of the white of two eggs, toast and cup of weak
tea. There was therefore present a ]5athologic leucocytosis
and a diminution in the erythrocytes, the cause of which, an

X. C. ]\rEDICAI. SOCIETY. 783

aeetaiiilid toxa'iiiia, was not hard to seek, other factors being
exehiderl bv careful inquiry. The kidney secretion in this
case was practically normal.

Another case that was of interest to me from the fact of my
first diagnosis gave me a history like this : A young lady,
aged 24, typewriter, consulted me on account of increasing
weakness, shortness of breath and nervousness. She had no-
ticed a blue color to the lips and finger nails. There was
occasional palpitation of the heart and a sense of throbbing in
the neck. For several years she had suffered from facial
neuralgia and later from severe headaches, which kept her
awake at nights. With these exceptions her health had been
good. Heaii: sounds indistinct and vibrating, with hemic
murmur at base of heart, but no murmur at apex. Lungs
negative. Spleen slightly enlarged. Reflexes normal. Slight
tremor in hands, but no enlargement of thyroid gland. Eyes
prominent. The blood examination showed the red blood
cells only 1,860,000 per cm. ; white blood cells, 19,000 per
cm. Color index low. A diagnosis of anaemia was made
and cardiac stimulants with iron, arsenic, etc., prescribed,
daily outdoor exercise and forced feeding.

The symptoms showed no signs of improvemient for four-
teen days, when it was discovered by inquiry that patient
was taking from three to six tablespoonfuls of bromo-seltzer
daily for her head, w^hich meant that she was getting from
thirty-six to seventy-two grains of acetanilid daily.

This was stopped and same treatment continued, when pa-
tient made a complete and steady recovery.

Another case difficult of diagnosis from the fact that pa-
tient did not consider herself sick nor desire medical atten-
tion, was that of a young married woman, aged 24, whose hus-
band first consulted me about her. The history, briefly, was
this: Following an ovariotomy she suffered pelvic pain and
a relative, who w^as a druggist, suggested phenalgin capsules
as a means of relief. At first she would get a dozen at a
time, and finding relief, began buying them by the bottle (a

784 FIFTY-FIFTH ANNUAL SESSION

rather expensive luxury when he think of five cents worth of
acetanilid ammonium carbonate and bicarbonate of soda for
$1.25). The relief was temporary, however, from this, and
as the pain returned more capsules were taken and in larger
quantities each week. This had been going on for more than
a year. She would sit for hours if undisturbed, complained
of being tired, and was unable to perform any muscular effort,
having dyspna3a on exertion. She was given to attacks of
despondency. The face was ashy white, lips and lobes of
ears were blue and the hands, at first apparently dirty, were
found cyanosed to the second joint. Mucous membranes
were pale. Expression vacant, tongue coated, breath the
foulest I ever noticed, and the pulse ranged from 85 at rest
to 130 on exertion, of low tension. Skin cold and lifeless.
General tremor of both station and fingers. The blood count
showed red blood cells only 2,600,000 per cm. ; the white
blood cells 11,000 per cm. ; color index low. Noting the
composition of phenalgin we find its chemical name is given
as phenylacetanide, which, according to Remson, is a chemi-
cal synonym for acetanilidum.

Hence a diagnosis of acetanilid toxjemia was made. The
drug was withdrawn, strychnia and digitalin in capsules were
given every four hours, pepto-mangan (Gude) was given be-
fore meals, and Fowler's solution of arsenic after meals; the
result being final and complete restoration.

The blood studies made in these cases were of unusual in-
terest to me, as I have never seen a report of blood counts in
slow acetanilid poisoning, and it showed the blood using its
usual army of fighters to ward off the toxaemia, with its in-
creased number of leucocytes just as it would in septicnemia
or appendicitis. On the other hand, we all see frequently the
cases of acute poisoning from acetanilid with the sudden onset
of blue lips and fingers, livid cyanosed face, forehead and
cheeks covered with beads of sweat, which gradually extend
over the entire body with the soft, slow compressible and
finally very weak pulse. Of this class I will only mention

N. C. MEDICAL SOCIETY. 785

one case, a child of twelve months with a general weeping
eczema, whose mother sent to the drug store for some healing
powders and was given equal parts of boric acid and ace-
tanilid. This was used frequently, when the above-named
symptoms appeared from absorption through the abrasions,
and the child was apparently dead when I first saw it. The
powder was removed and stimulants with atropine given, and
hot normal saline solution used, with a final recovery. While
I have never seen oxygen used for these cases, it seemed par-
ticularly indicated in this case, especially when we think of
the depressing effect of acetanilid has on the oxygen-carrying
.power of the red blood cells. To summarize, it shows posi-
tively that we can get symptoms of acute poisoning from ace-
tanilid where it is used as a dusting powder on abraded sur-
faces in young children or the debilitated, as well as when
taken by mouth. It should be kept in mind in prescribing
acetanilid mixtures that no action is produced by them on
the cure of the disease. They are of value in the treatment
of symptoms, mainly such as relieving pain and reducing
temperature, and all such prescriptions should be marked,
"Not to be refilled." Therefore, to obtain permanent results,
other measures can be employed which are of greater value.
In cases of fever the patient is not made better by these drugs,
but, on the other hand, convalescence is prolonged. The ef-
fects of antipyretics varies, not only with the dose, but with
the individual patient. Many can take without harm appa-
rently very large doses of these preparations, while in others
minute quantities produce alarming symptoms.

786 FIFTY-FIFTH ANNUAL SESSION

MORPHmE AND KINDRED DRUGS: THETR USE
AND ABUSE.

BY JJ. A. GAREISON, M.D., BESSEMER CITY, N. C.

The object of this paper is, not to set out anything espe-
cially new, but to state a few facts, briefly, as I have found
them by experience.

Opium is a stimulant, narcotic, anodine, antispasmatic and
intoxicant. To get at the facts that I want to set forth, 1
shall necessarily have to touch briefly on its physiological
action.

Its taste is bitter and somewhat acrid ; it causes dryness of
the mouth and throat, and therefore causes a huskiness of
the voice, which is easily detected; it restrains movements of
the bowels and dries all secretions except secretions of the
skin. Opium as a stimulant should be given in small doses.
Eive drops of the tincture have good effects in cases of weak
and dilated heart. Morphine given hypodermically has fine
effect on asthma, pleural effusion — respiration becomes easier
and lividity disappears and sleep is rendered profitable. In
bronchial and luug trouble, opium combined with a good ex-
pectorant mixture depresses cough and quiets the patient.

In pneumonia, opium is of advantage in relieving pain and
extensive cough — here it is better given in form of Dover's
powders ; in typhus, typhoid fever, smallpox, etc., small doses
are of great advantage, given at night to maintain the strength
of the patient. It is given in all forms of neuralgia and
ovarian and menstrual troubles. Where deep burns occur,
hypodermic use of morphine is invaluable.

Herpeszoster is another malady, in which morphine given
with atropine is of notable service. It is one of the most im-
portant ingredients in all cough remedies. Opium and
codeine are used with some degree of success in diabetes. In
entercolitis and all forms of bowel troubles in children, it is

N. C. MEDICAL SOCIETY. 787

almost prohibited, because of the effect it has upon the brain ;
if given at all, it must be given by rectum and starch water
enemata and hydrate of chloral.

Morphine given subcutaneouslj is a good remedy in vomit-
ing of pregnancy, nausea, nervous vomiting and all forms of
colic. Large doses should be given in lead colic. Some pa-
tients can not stand opium in any form, but, on the other
hand, others stand it too well. No one, not even a physician,
should take opium in any form at his own instance. I think
taking a small dose to relieve toothache, headache or any other
ache, should be prohibited by the law, except it be prescribed
by a physician, and then it should be cautiously given. Some
of the bright minds in our profession are ruined by being
overworked and rundown and, to hold up, begin taking mor-
phine and cocaine.

It is only a matter of time when he becomes a great doper
and, sooner or later, it gets the best of him ; it renders him
worthless — the truth is not in him. I would to God that all
the profession would stay clear of these terrible, destructive
drugs.

Now, since we have prohibition in this State, we must be
more careful how and for whom we prescribe the drugs ; be-
cause it looks as though the American people are compelled
to have something to take that they can feel the effects of.
We, as physicians, should not be satisfied with being healers
or curers of diseases, but we should be preventers of diseases
and drug habits. It is an awful thing to see a bright mind
destroyed by these drugs, which are almost as necessary as
the food we eat. I claim that ninety per cent of all the
cocaine and morphine fiends are caused by the attending phy-
sician. He will go to see the poor sufferer and give him a
good large dose — it will relieve and the patient will want
the same thing when the pain returns — the doctor can not go
or does not want to go, and sends a dose of morphine, and
the patient, of course, becomes happily relieved of the pain.

788 FIFTY-FIFTH ANNUAL SESSION

Well, thej will ask the physician what it w^as. Why do they
ask? So that they may get some and keep it on hand in
case of an attack, and I have never seen a case but what the
pain would return about the same time of day or night, if the
habit is once formed. I think we, as physicians, should not
even tell our patients what they are taking, and when we are
compelled to give opium, give it in combination with some-
thing else so that the patients will not know what they are
taking. I often read of great crimes committed, such as
suicides, homicides, thefts, etc., and when we look into the
cause we find in 25 per cent of the cases some vicious habit,
and mostly the morphine and cocaine. I hope that you can
enforce the laws of our State and stop the druggists from sell-
ing these drugs to any one except on a prescription. I find^
already, people buying tincture of opium, camphorated, to
get the alcohol in it. I know a young man who can drink
an ounce of paregoric and feel good almost a half a day on it.
We must ask our next Legislature to enact prohibitory laws
of the great evil. I admit we must have opium and kindred
drugs, but we must control it ; if we do not control it, it will
control us. I hope the profession will see the great danger
we are in, when the whiskey is gone, and prejDare themselves
to meet it. Let us all work together to build up mankind
and not to tear him down.

N. C. MEDICAL SOCIETY. 789

EARLY EECOGNITIOK AND TREATMENT OF
TOXIC AMBLYOPIA, AS CAUSED BY THE ABUSE
OF ALCOHOL AND TOBACCO.

BY J. H. HOXNETT, M.D., WILMINGTON, X. C.

The term ''amblyoijia" implies impairment of vision due to
lack or loss of sensibility in the optic nerve, or its anatomical
continuation, the retina.

Under the heading of toxic amblyopia belong those cases
primarily due to the presence of poisonous materials in the
blood. These materials may have their origin in the body,
as in ursemia, diabetes, malaria, and certain infectious con-
ditions, or may be introduced into the system, as in the cases
of alcohol, tobacco, and lead; also, occasionally, by certain
drugs, namely — quinine, santonin, etc.

These cases, due to excessive use of alcohol or tobacco,
usually to both, are most common, and if seen early enough,
are so easily recognized and so amenable to treatment that I
feel a few words on this subject may prove beneficial to the
practitioner when not within the reach of men doing special
eye work ; enabling him to correctly diagnose, and, by prompt
treatment, prevent the disastrous consequences too often at-
tendant in these cases.

I shall pass very briefly over the pathology. In early
stages, and even later, in some eases, there are few or no
structural changes, "the functional disturbances being probably
caused by poisoning of the nerve centers.

If the means for an intra-ocular examination with the
ophthalmoscope be at hand, the edge of the optic disc may ap-
pear blurred and irregular, and the disc itself rather pale.
In neglected cases, the disc becomes atrophic and dead white
in color, this atrophy at times extending backward into the
optic nerve.

The usual picture of these cases is as follows : A male,

790 FIFTY-FIFTH ANNCJAL SESSION

around middle age, comj)lains that both far and near vision in
both eyes is failing rather rapidly. Patient will lay more
stress on the defection of distant vision. General examina-
tion of the eye is negative.

We elicit a history of constant use of strong pipes and
chewing tobacco. Patient, after some questioning, admits
that he uses alcohol steadily, and has done so for years, in
the form of whiskey or brandy. In the absence of other signs
pointing to the cause of failing vision, the following simple
little test may be applied : Two discs, one of bright red paper,
and the other of green, each round, and about one-tenth of an
inch in diameter, should be attached to handles, such as small
pegs of wood. The patient is directed to close one eye ; one
of the colors is held directly, in the central line of vision, at a
distance of from twenty to forty inches away from the open
e^^e. This is repeated with the other color, and the patient
is asked to name each color. If the defect of sight is due to
alcohol or tobacco, patient will be unable to name either color,
or will do so incorrectly. This test is repeated with the other
eye, the object being to establish the presence or absence of
central scotoma, or blind spots, for red and green. This is
an early and constant sign in the condition under consid-
eration.

Some of the older authorities consider tobacco a more
potent factor in causation, and point to some cases where there
is no history of alcohol. I recall the case of a man who has
continued to drink steadily and heavily, but has given up
tobacco entirely, and he has improved to a great degree; yet,
it is probable that nearly all cases are due to the combined
habits.

The treatment is simple. Alcohol and tobacco are to be
absolutely and positively interdicted. Strychnine in doses of
from one-thirtieth to one-twentieth of a grain is to be adminis-
tered three times daily. Potassium iodide in the saturated
solution is to be given, in doses ranging from twenty-five to

N. C. MEDICAL SOCIETY. 791

forty drops, three times daily, according to gastric tolerance.
Hot and cold Laths, massage, rest, a general tonic regime, and
liberal diet, are useful adjuncts.

The progress toward recovery will be most gratifying, the
patient often regaining normal, or greatly improved, vision,
in a few weeks.

In conclusion, I apologize to you gentlemen for presenting
to you this simple paper, containing facts probably already
known to you, but I am inspired to do so, for the reason that,
from time to time, cases of this kind come within my obser-
vation, unfortunately too late, and the patient is doomed to
wander in darkness, whereas, if the nature of the case had
been understood and properly treated in the early stages, sight
and usefulness could have been restored.

792 FIFTY-FIFTH ANTTUAL SESSION

A BKIEF REPOET OF SOME CASES WHICH HAVE
YIELDED SUEPRISINGLY TO ELECTRICITY,
TO X-RAY TREATMENT, SNOW'S TUBES AND
MECHANICAL VIBRATION.

BY J. THOMAS WEIGHT, M.D., WINSTON^ N. C.

Mr. Preside7it and Gentlemen:

The object of this paper, however brief, is to stimulate
original research and investigation along the lines here out-
lined, as some results which I have, in some instances, unex-
pectedly achieved, have led me to believe that much more may
be done with the X-Ray, violet light, electricity and me-
chanical vibration, or what I am pleased to call ''physical
medicine," than we at present dream of.

To get a thorough understanding of the principles of treat-
ment by physical or mechanical means we have to revert to
the "cellular theory" and remember that the whole body is
composed of an enormous aggregation of individual and dis-
tinct classes of cells, viz: nerve cells, bone cells, muscle cells,
blood cells, etc., and that "omnia cellula cellulse," and also
that these cells can not functionate without proper meta-
bolism, nutrition and elimination, which presupposes a proper
or normal circulation of the blood, and exercise, or function-
ating of the cell itself.

Thus it is easy to see that any impairment or stagnation
of the circulation — due to inactivity, heart disease, cirrhosis
or other disease — would in a measure be detrimental to cellu-
lar activity and the proper performance of duty. Again, if
the particular cells composing a certain organ of the body be
starved, irritated or impaired by disease, it is reasonable to
suppose that the activity and secretions of that organ would
be correspondingly impaired and vitiated. Also, if the "nerve
force" generated by the nerve cells of the brain, cord and sym-
pathetic plexuses be weak and below par from inanition or

N. C. MEDICAL SOCIETY. 793

lack of nutrition, irritation by toxins, or from other causes,
we will necessarily have impairment of activity or function
of that organ or organs involved and supplied by nerve
branches from those particular nerve cells, and a deterioration
of the quality as well as the quantity of the secretions ordi-
narily generated or produced by them.

So much for cellular pathology.

JSTow, electricity, vibration, X-Kay, light, massage, etc., act.
as we know, directly and indirectly by cellular stimulation,
forcing the cells into action, and also by inhibition ; prevent-
ing germ growth and disease.

Applied over the centers in the cord, as well as over the
organs themselves, to arouse their ganglia and other nerve and
cell tissue, vibration — either electrical or mechanical — will
produce most gratifying results in awakening to normal ac-
tion cells and organs long dormant. Coupled with "mental
therapy," in the shape of healthful aad wholesome sugges-
tion, you have a most potent factor for good and to combat
diease.

In my study of these physical aids to regular drug medica-
tion, I have made numerous experiments, especially with the
X-Eay, in cases which to me seemed to offer some hope of
success, or in which I thought treatment by that means appli-
cable, and have in most instances been rewarded, while in
other cases the results were nil. Still, the cures so obtained
were so vastly superior to results heretofore obtained, that I
felt justified in striking out for myself along original lines of
investigation; and I predict that within a very few years pure
and simple drug medication — -if antitoxins, opsonins and
animal therapy be not included — will occupy an obscure place
in scientific medicine.

I report below a few eases of widely different natures, or
characteristics, with results as to treatment :

Case XX. — Mr. S ; age 52. Diagnosis: Epithelioma

of the inner portion of right eyelid, involving the tear duct

794 FIFTY-FIFTH ANNUAL SESSION

and side of nose, conjunctiva, etc. This man, a merchant
and pawnbroker here in the city, had been treated both in
New York and in Boston by skin and eye specialists, with
only temporary benefit. In his case I used only the X-Ray —
small soft tube — concentrating the rays by mea^is of my
funnel-shaped "concentrator," to a volume corresponding in
size to the affected area.

The treatments lasted fifteen minutes each — the tube
placed at a distance of nine inches from the face — the face,
eyebrows, hair and other exposed portions of the body being,
of course, protected.

Twelve treatments, 48 to 72 hours apart, completely cured
his trouble without noticeable scar or injury to sight. After
one year's time there is no return of the disease.

Case XIV. — Mrs. D ; age 58. Diagnosis: Carcinoma

of left breast, with great glandular enlargement, involving
the left axilla and lower cervical region. This patient, a

married lady, referred to me by Dr. F , of this city, had

marked cachexia and general declining health, as she had
been suffering for twelve or fifteen months with the cancer,
which, at the time I saw it, had an ulcerating surface of two
and a half inches in diameter, and half an inch deep, while a
hard cake some four inches in diameter occupied the deeper
structures of the breast, and a similar mass occupied the left
axilla, as before mentioned. I treated this case about three
months with the hope of prolonging life and rendering the
patient comfortable. To my surprise the patient made an
apparent cure — the idceration ceased and the place healed
over, the glandular masses in the breast and axilla decreased
in size and practically disappeared, and I had hopes that the
patient would make a complete recovery. But, about six or
eight weeks after I ceased treating her she developed a stom-
ach trouble, which I have reason to believe was of a cancerous
nature — probably developed from metastasis — and after a

N. C. MEDICAL SOCIETY. 795

few weeks illness died. I did not see her during that illness,
but obtained the facts from Dr. F , her family physician.

This was a case where procrastination proved suicidal, loi
had her case been treated early she would have made a com-
plete recovery, and no doubt lived many years.

In this case I used only the X-Kay, in the manner described
above in Case XX, both over the ulcerated area and over the
glandular enlargements.

It is remarkable how the X-Ray will ease the horrible pain
due to cancer. In cases of this nature the eliminating organs
should be kept specially active during treatment, so as to
throw off the toxins and other effete material produced by
the destruction of the cancer and the unavoidable absorption
which takes place. This fact should not be forgotten.

Case X. — Miss S ; age 19. Diagnosis: Acne of face,

complicated with scaly or desquamative eczema. Duration,
two years.

Treatment. — Corrected diet and menstrual irregularity ;
pressed out the black-heads and opened the pustules, and or-
dered an antiseptic lotion. I gave treatment with Snow's
vacuum tube over the face, gave the static wave current, and
used mechanical vibration over the face and spinal centers,
followed later by short exposures by the X-Kay (5 to 8 min-
utes)— the hair, eyes and brows being protected. Treatment
occupied six weeks. Result : Cured, patient being left with
a fine complexion.

Case XXV. — Mrs. M . Policeman's wife; aged 42.

Diagnosis : Chronic eczema of hands, arms, front of shoulders
and neck and part of face. Cervical glands enlarged. Du-
ration, five years.

In this case the X-Eay, with soothing lotions and oint-
ments, were used, but sole reliance was placed on the X-Ray.
Result: After some six or eight thorough treatments, occupy-
ing three weeks, the patient was discharged cured. During
a period of nearly two years there has been no return of the
disease.

796 FIFTY-FIFTH ANNUAL SESSION

In this case the prompt reduction of the enlarged glands
in the neck induced me to try the X-Ray in the case below :

Case XL. — Young man, aged 23. Diagnosis: Cervical
adenitis, with suppuration; probably tuberculous.

In this case I prescribed tonics, nutritious diet, open air,
sleeping on the porch, etc., and used the X-Ray directly over
the diseased glands — distance, nine inches ; time, fifteen min-
utes, followed by absorptive local applications, such as anti-
phlogistine, etc.

I treated this case for six weeks, giving an X-Ray exposure
from two to three times per Aveek, when the disease entirely
disappeared, with the patient's weight increased and general
health greatly improved.

Case XLII. — Mrs. ; age 39. Diagnosis: Multiple

fibroids — seven in number. Size : from a cocoannt down to
a marble.

This case has been of great interest to me, as the practical
removal of these fibroids has been entirely nonsurgical. Mas-
sey, Morton and others claim fine results from electrical treat-
ment alone, but in this case I used combined treatment, bring-
ing into play not only electricity in its various forms, but the
X-Ray, Snow's tubes — both vaginal and rectal — electrical and
mechanical vibration and drugs, with most gratifying results
as to cure.

Patient married fourteen years — no children. Trouble
from fibroids, malposition, etc., dated back six years. Treated
at sanitariums in Atlanta and in Richmond without perma-
nent results. Would not submit to an operation. General
health fair — some constipation and digestive disturbance.
Rather nervous and excitable. Temperament, emotional.

The treatment in this case was, aside from the tonic effect
of the electricity and Aibration, purely experimental — with
the patient's consent, of course. To go into every detail of
treatmemt would be tedious, so I shall content myself with
giving only a synopsis or general outline. The patient was

N. C. MEDICAL SOCIETY. 797

given Morton's wave current for its tonic effect, and because
of its property of stimulating metabolism. Negative insu-
lation and the crown breeze were given for their soothing
effect upon the nerves. The induced current was used by
uterine electrode. Snow's tubes were used alternately per
vagina, rectum and in utero (time 20 minutes). Vibration —
heavy strokes — was used directly over uterus and over the
lumbar portion of the cord, also over the liver and large in-
testine. The X-Ray was used with the speculum per vagina,
the parts being well protected by tin or lead sheets, and an
effort made to throw the rays directly upon the tumors, A
larger X-Ray tube was then used to throw the rays through
the tumors by way of the abdomen. Remembering how can-
cers, enlarged glands and other abnormal growths disintegrate
and absorb, or disappear under X-Ray treatment, and how
destructive the rays are to germ life, I felt justified in this
method of treatment and that the time would not be entirely
wasted, and hence watched the result of treatment with great
interest. The identity of the uterus, at the beginning of
treatment, was entirely lost in the midst of the masses of
fibroid tissue, which, aside from one large intramural — or in-
terstitial— tumor, presented the sub-peritoneal type. As
treatment progressed, however, the tumors began to gradually
diminish in size until the outlines of the uterus became distin-
guishable, and later quite separate and apart from the tumors,
which seemed to develop pedicles as the shrinkage or absorp-
tive process continued. I wish to state that as to medication,
that thyroid extract to the point of toleration was the only
medicament used. The treatment of this case on the plan
outlined above was continued about seven and a half months,
and when last seen there were only the merest rudiments of
the original masses of fibroid tissue.

Later I learned that the patient had conceived. I shall
watch this case with much interest.

While the above case is not entirely satisfactory from a
clinical standpoint, and it is too early to say what the final

798 FIFTY-FIFTH ANNUAL SESSION

outcome will be, yet I do not anticipate any return of the
trouble — the menopause being near at hand — and I do know
that the weight, enlargement and discomfort incident to the
tumors disappeared entirely, and the whole physical condition
became greatly improved.

The result of this case gives promise of much in tumors,
neoplasms or other abnormal growths. I shall continue my
investigations along this line, as the field offers great possi-
bilities.

The above are a few of many interesting and illustrative
cases which I have not here time to narrate.

A few words as to the value of vibration and Snow's tubes.
and I am done.

I find both electrical vibration (by means of a very short
spark gap — using direct spark), and mechanical vibration,
useful in cases of constipation, torpidity of the liver, indiges-
tion, neurasthenia, insomnia, muscular rheumatism, neural-
gia, sciatica, partial paralysis, etc., and have always obtained
results ; but to get results the treatment must be carried out
intelligently, persistently and with regularity.

Snow's tubes give good results in catarrhal troubles — ca-
tarrh of any mucous membrane, no matter where situated.
It also gives surprising results in enlaiged prostate (urethral
and rectal tubes), and in stricture. Piles, unless too large,
yield readily to this mode of treatment. I also cured a case
of fistula in a physician of our city, where operations failed to
benefit.

The intelligent physician will find many opportunities in
his practice to use these methods of treatment, and get results
where drug medication has proven entirely worthless.

Gentlemen, I will close, with the wish that these few words
may cause some of you to cut loose somewhat from the beaten
paths and to think and work for yourselves, and that medicine
in the South may soon occupy a position in the van of medical
progress of the world.

Memoranda.

At tlie forty-ninth annual session of the Medical Society of the State
of North Carolina in Wilmington, N. C, in 1902, the address of the
President, Dr. Robert S. Young, contained the following:

"At the St. Paul (1901) meeting of the American Medical Association,
a new Constitution and By-laws were adopted. The American Medical
Association earnestly requests the cooperation of our Society in its or-
ganization. The officers of that Association asked me to bring the mat-
ter befoie you. I herewith transmit the correspondence, and beg you to
authorize a special committee to consider this subject and report during
this meeting."

Page 33, Transactions of the same session, contains the following:

"The Committee on the President's Message reported in favor of the
suggestions made; * " * they recommend that a committee be ap-
pointed to draft a constitution along the lines laid down by the American
Medical Association, and to report to the next meeting of the Society.

"The President appointed the following committee on a new constitu-
tion: Drs. J. Howell Way, M. H. Fletcher, H. A. Royster, J. A. Bur-
roughs, Geo. W. Pressly."

In accordance with the instructions therein contained, the committee
carefully considered tlie matter, and after a most critical study of the
whole subject, submitted the Constitution and By-laws as contained in
the following pages for the action of the Society.

At the fiftieth annual session in Hot Springs, N. C, beginning June
3, 1903, Dr. A. W. Knox, President, the report of the committee was
accepted and made the subject of a full and free discussion e.xtending
over a portion of two days, when the Society unanimously adopted the
Constitution and By-laws as reported by the committee and contained
in the following pages.

CONSTITUTION AND BY-LAWS

OV THE

Medical Society of the State of NortK Carolina

[Adopted at the Fiftieth Annual Session, Hot Springs, N. C,
June 3-5, 1903.

ARTICLE I. — Title of the Society.

The name and title of this organization shall be "The Medical Society
of the State of North Carolina."

ARTICLE II. — Purposes of the Society.

The purpose of this Society shall be to federate and bring into one
compact organization the entire medical profession of the State of
North Carolina, and to unite with similar oiganizations in other States
to form the American Medical Association; with a view to the extension
of medical knowledge, and to the advancement of medical science; to
the elevation of the standard of medical education, and to the enact-
ment and enforcement of just medical laws ; to the promotion of friendly
intercourse among physicians, and to the guarding and fostering of
their material interests; and to the enlightenment and direction of
public opinion in regard to the great problems of state medicine; so
that the profession shall become more capable and honorable within
itself, and more useful to the public in the prevention and cure of dis-
ease, and in jirolonging and adding comfort to life.

ARTICLE III.— CoMPO?iExXT Societies.

Component societies shall consist of those district and county medical
societies which hold charters from this State Society.

ARTICLE IV. — Composition of the Society.

Section 1. This Society shall consist of Members, Delegates, Guests,
Honorary Members, and Honorary Fellows.

Sec. 2. Members. — The members of this Society shall be the mem-
bers of the component county medical societies.

Sec. 3. Delegates. — Delegates shall be those members who are elected
in accordance with this Constitution and By-laws to represent their
respective component coimty societies in the House of Delegates of
this Society.

Sec. 4. Guests. — Any distinguished physician not a resident of this
State may become a guest during any annual session upon invitation
of the Society, or its Council, and shall be accorded the privilege of
participating in all of the scientific work for that session.

Sec. 5. The Honorary Members shall consist of such regular physi-
cians as have won distinction by their contributions to medical science;
those elderly physicians who, prior to their retirement from practice.

N. (J. MEDICAL SOCIETY. 801

have displayed a proper interest in the welfare of thin Society, or
who, by their example, have reflected credit and honor upon the pro-
fession. They must be nominated by the Council and receive a two-
thirds vote of the members of the House of Delegates present at the
meeting at which their names are presented for election. They shall
be exempt from all dues and fines, and shall be entitled to all the
privileges of the Society, except the right to vote and hold office.

Sec. 6. The Honorary Fellows shall consist of such physicians as
have been members of this Society continuously for thirty years, and
whose dues have been paid during that time. They shall receive a two-
thirds vote of the members of the House of Delegates present at the
meeting at which their names are proposed for promotion. They shall
be exempt from all dues and fines, and shall be entitled to all the
privileges enjoyed by active members in good standing.

ARTICLE V. — House of Delegates.

The House of Delegates shall be the legislative and business body of
the Society, and shall consist of ( 1 ) delegates elected by the component
county societies, and (2) ex officio the officers of the Society as defined
in this Constitution.

ARTICLE VI. — Sections and District Societies.

The House of Delegates may provide for a division of the scientific
work of the Society into appropriate sections, and for the organization
of such councilor district societies as will promote the best interests
of the profession, such societies to be composed exclusively of members
of component county societies.

ARTICLE VII. — Sessions and Meetings.

Section 1. The Society shall hold an Annual Session, during which
there shall be held daily not less than two General Meetings, which shall
be open to all registered members, delegates and guests.

Sec. 2. The time and place for holding each Annual Session shall be
fixed by the House of Delegates.

ARTICLE VIIL— Officers.

Section 1. The officers of this Society shall be a President, three
Vice-Presidents, a Secretary, a Treasurer, and ten Councilors.

Sec. 2. The President and Vice-Presidents shall be elected for a term
of one year. The Secretary, Treasurer and Councilors shall be elected
for terms of three years each. All of these officers shall serve until
their successors are elected and installed.

Sec. 3. The officers of this Society shall be elected by ballot, a
majority of the votes cast being necessary to elect, by the House of
Delegates on the morning of the last day of the Annual Session, but
no Delegate shall be eligible to any office named in the preceding section,
except that of Councilor, and no person shall be elected to any such
office who is not in attendance upon the Annual Session and who has not

802 FIFTY-FIFTH ANNUAL SESSION

been a member of the Society for the jjast three years. Any nominee
for the ofTice of President shall have been an active member of the
Society for five years, including the year of his election, shall have
attended two of three meetings immediately preceding his nomination,
including the meeting at which he is nominated; and shall be a mem-
ber in good standing at the time of his nomination.

AETICLE IX. — The Board of Medical Examiners.

Section 1. The seven members of the "Board of Medical Examiners
of the State of North Carolina" shall be elected by ballot for a term
of six years, a majority of the votes cast being necessary to a choice.
The election shall be held on the second day of the annual meeting, and
the balloting shall continue until the entire number is elected.

Sec. 2. A vacancy occurring from any cause other than expiration
of term of office, shall be filled by the board or a quorum thereof.

Sec. 3. The elective members of the State Board of Health, and of
the State Board of Medical Examiners for Nurses, shall be elected by
ballot on the second day of the session.

ARTICLE X. — Funds and Expenses.

Funds for meeting the expenses of the Society shall be arranged for
by the House of Delegates by an equal per capita assessment ui^on
each county society, to be fixed by the House of Delegates, by voluntary
contribution, and from the profits of its publications. Funds may be
appropriated by the House of Delegates to defray the expenses of the
annual sessions, for publication, and for such other purposes as will
promote the welfare of the Society and profession.

ARTICLE XL— Referendum.

The general meeting of the Society may, by a two-thirds vote, order
a general referendum upon any question pending before the House of
Delegates, and the House of Delegates may, by a similar vote of its
own members, or after a like vote of the general meeting, submit any
such question to the membership of the Society for a final" vote; and
if the persons voting shall comprise a majority of all the members of the
Society, a majority of such vote shall determine the question, and be
binding upon the House of Delegates.

ARTICLE XII.— The Seal.

The Society shall have a common seal, with power to break, change
or renew the same at pleasure.

ARTICLE XIIL— Amendments.
The House of Delegates may amend any article of this Constitution
by a two-thirds vote of the delegates registered at that annual session,
provided that such amendment shall have been presented in open
meeting at the pievious annual session, and that it shall have been sent
officially to each component county society at least two months before
the session at which final action is to be taken.

N. C. MEDICAL SOCIETY. 803

By-Laws.

CHAPTER I.— AlEMBEKSHIP.

Section 1. All members of the component county societies shall be
privileged to attend all meetings and take part in all of the proceedings
of the annual sessions, and shall be eligible to any office within the gift
of the Society.

Sec. 2. The name of a physician upon the properly certified roster
of members or list of delegates, of a chartered county society which
has paid its annual assessment, shall be prima facie evidence of his right
to register at the annual session in the respective bodies of this Society:
Provided, that licentiates of the State Board of Medical Examiners
may, if the House of Delegates so elects, at the meeting of the Society
at which they receive license, be entitled to register upon payment of
the annual dues for that year, and be accorded all the privileges of
other members for that year, the Secretary of the Society entering
their names and so certifying to the Secretary of the county society
where the said licentiates reside, but said licentiates desiring to continue
membership in this Society must affiliate with their local county society.

Sec. 3. No person who is under sentence of suspension or expulsion
from any component society of this Society or whose name has been
dropped from its roll of members, shall be entitled to any of the rights
or benefits of this Society, nor shall he be permitted to take any part
in any of its proceedings until such time as he has been relieved of
such disability.

Sec. 4. Each member in attendance at the annual session shall enter
his name on the registration book, indicating the component society
of which he is a member. When his right to membership has been veri-
fied by reference to the roster of his society, he shall receive a badge,
which shall be evidence of his right to all the privileges of membership
at that session. No member or delegate shall take part in any of the
proceedings of an annual session until he has complied with the pro-
visions of this section.

CHAPTER II. — AxxuAL and Special Sessions of the Society
Section 1. The Society shall hold an annual session at such time and

place as has been fixed at the preceding annual session.

Sec. 2. Special sessions of either the Society or House of Delegates

shall be called by the President at his discretion, or upon petition

of twenty delegates.

CHAPTER III.— General Meetings.
Section 1. The general meetings shall include all registered members,
delegates, and guests, who shall have equal right to participate in the
proceedings and discussions; and, except guests and honorary membeis,
to vote on pending questions. Each general meeting shall be presided
over by the President, or in his absence or disability, or by his request.

804 Fll-TY-KIKTII ANNUAL SESSION

by one of the Vice-Presidents. Before it, at such time and place as
may have been arranged, shall be delivered the annual address of the
President, and the annual orations, and the entire time of the session,
so far as may be, shall be devoted to papers and discussions relating to
scientific medicine.

Sec. 2. The general meeting shall have authority to create committees
or commissions for scientific investigations of special interest and
importance to the profession and public, and to receive and dispose of
reports of the same; but any expense in connection therewith must
first be approved of by the House of Delegates.

Sec. 3. Except by special vote, the order of exercises, papers and
discussions, as set forth in the official program shall be followed from
day to day until it has been completed.

Sec. 4. No address or paper before the Society, except those of tlie
President, Orator and Essayist, shall occupy more than twenty minutes,
in its delivery; and no member shall speak longer than five minutes
nor more than once on any subject.

Sec. 5. All papers read before the Society shall be its property.
Each paper shall be deposited with the Secretary when read, and if this
is not done it shall not be published.

CHAPTER IV.— House of Delegates.

Section 1. The House of Delegates shall meet annually at the time
and place of the annual session of the Society, and shall so fix hours
of meeting as not to conflict with the first general meeting of the Society,
or with the meeting held for the address of the President and the
annual orations, and so as to give delegates an opportunity to attend
the other scientific proceedings and discussions so far as is consistent
with their duties. But if the business interests of the Society and
profession require, it may meet in advance, or remain in session after
the final adjournment of the general meeting.

Sec. 2. Each component county society shall be entitled to send
to the House of Delegates each year one delegate for every twenty-
five members, and one for each major fraction thereof, but each county
society holding a charter from this Society which has made its annual
report and paid its assessment as provided in this Constitution and
By-laws, shall be entitled to one delegate.

Sec. 3. A majority of the registered delegates shall constitute a
quorum, and all of the meetings of the House of Delegates shall be
open to members of the Society.

Sec. 4. It shall, through its officers. Council, and otherwise, give
diligent attention to and foster the scientific work ana spirit of the
Society, and shall constantly study and strive to make each annual
session a stepping-stone to future ones of higher interest.

Sec. 5. It shall consider and advise as to the material interests of
the profession, and of the public in those important matters wherein
it is dependent upon the profession, and shall use its influence to secure

X. C. MEDICAT, SOCIETY. 805

and enforce all proper medical and public health legislation, and to
diffuse popular information in relation thereto.

Sec. 6. It shall make careful inquiry into the condition of the pro-
fession of each county in the State, and shall have authority to adopt
such methods as may be deemed most efficient for building up and in-
creasing the interest in such county societies as already exist, and for
organizing the profession in counties where societies do not exist. It
shall especially and systematically endeavor to promote friendly inter-
course between physicians of the same locality, and shall continue these
efforts until every physician in every c-ounty of the State who can be
made reputable has been brought under Medical Society influence.

Sec. 7. It shall encourage post-graduate work in medical centers,
as well as home study and research, and shall endeavor to have the re-
sults of the same utilized and intelligently discussed in the county
societies. (With these ends in view, five years after the adoption of
these By-laws, except by unanimous consent of the Committee on Scien-
tific Work, no voluntary paper shall be placed upon the annual pro-
gram, or be heard in the Association, which has not first been read
in the county society of which the author is a member.)

Sec. 8. It shall elect representatives to the House of Delegates of
the American Medical Association in accordance with the Constitution
and By-laws of that body, in such a manner that not more than one-
half of the delegates shall be elected in any one year.

Sec. 9. It shall, upon application, provide and issue charters to
county societies organized to conform to the spirit of this Constitution
and By-laws.

Sec. 10. In sparsely settled sections, it shall have authority to
organize the physicians of two or more counties into societies, to be
designated by hyphenating the names of two or more c-ounties, so as
to distinguish them from district and other classes of societies, and
these societies, when organized and chartered, shall be entitled to all
the privileges and representation provided herein for county societies,
until such counties may be organized separately.

Sec. 11. It may divide the counties of the State into ten councilor
districts, and, when the best interest of the Society and profession
will be promoted thereby, organize in each a district medical society,
to meet midway between the annual sessions of this Society, and mem-
bers of the chartered county societies, and none others, shall be mem-
bers in such district societies. (When so organized from the presidents
of such district societies shall be chosen the Vice-Presidents of this
Society, and the presidents of the c-ounty societies of the district shall
be the vice-presidents of such district societies.)

Sec. 12. It shall have authority to appoint committees for special
purposes from among members of the Society who are not members Of
the House of Delegates, and such committees may report to the House
of Delegates in person, and may participate in the debate thereon.

806 FIFTY-FIFTH ANNUAL SESSION

Sec. 13. It shall approve all memorials and resolutions issued in
the name of the Society before the same shall become effective.

Sec. 14. It shall present a summary of its proceedings to the last
general meeting of each annual session, and shall publish the same
in the transactions.

CHAPTER v.— Election of Officers.

Section 1. All elections shall be by secret ballot, and a majority of
the votes cast shall be necessary to elect: Provided, that when only
one name is to be ballotted for, the Society may suspend the rules and
declare the same elected by consent.

Sec. 2. The House of Delegates, on the first day of the annual ses-
sions, shall select a Committee on Nominations, consisting of ten dele-
gates, no two of whom shall be from the same councilor district. It
shall be the duty of this committee to consult with the members of the
Society, and to hold one or more meetings, at which the best interests
of the Society and of the profession of the State for the ensuing year
shall be carefully considered. The committee shall report the result
of its deliberations to the House of Delegates in the shape of a ticket
containing the name of one member for the office of President, and
one member for each of the other offices to be filled at that annual
session.

Sec. 3. The report of the Nominating Committee and the election of
officers shall be the first order of business of the House of Delegates
after the reading of the minutes on the morning of the last day of the
general session.

Sec. 4. Nothing in this Article shall be construed to prevent addi-
tional nominations being made by members of tlie House of Delegates.

Sec. 5. Any person known to have solicited votes for or sought any
office within the gift of this Society, shall be ineligible for any office
for two years.

CHAPTER VI.— Duties of Officers.

Section 1. The President shall preside at all meetings of the Society
and of the House of Delegates ; shall appoint all committees not other-
wise provided for; shall deliver an annual address at such time as
may be arranged; shall give a deciding vote in case of a tie, and shall
perforju such other duties as custom and parliamentary usage may
require. He shall be the real head of the profession of the State during
his term of office, and, as iar as practicable, shall visit by appointment
the various sections of the State and assist the councilors in building
up the county societies, and in making their work more practical and
useful.

Sec. 2. The Vice-Presidents shall assist the President in the discharge
of his duties. In the event of his death, resignation or removal, the
Council shall select one of the Vice-Presidents to succeed him.

N. C. MEDICAL SOCIETY. 807

Sec, 3. The Treasurer shall give bond for the trust reposed in him
whenever the House of Delegates shall deem it requisite. He shall,
demand and receive all funds due the Society, together with the be-
quests and donations. He shall, under the direction of the House of
Delegates, sell or lease anj^ estate belonging to the Society, and execute
the necessary papers; and shall, in general, subject to such direction,
have the care and management of the fiscal affairs of the Society. He
shall pay money out of the treasury only on a written order of the
President, countersigned by the Secretary; he shall subject his ac-
counts to such examination as the House of Delegates may order, and he
shall annually render an account of his doings and of the state of the
funds in his hands. He shall charge upon his books the assessments
against each component county society at the end of the fiscal year;
he shall collect and make proper credits for the same, and perform such
other duties as may be assigned to him.

Sec. 4. The Secretary, acting with the Committee on Scientific Work,
shall prepare and issue the programs for and attend all meetings of
the Society, and of the House of Delegates, and he shall keep minutes
of their respective proceedings in separate record books. He shall be
custodian of all record books and papers belonging to the Society, ex-
cept such as properly belong to the Treasurer, and shall keep account
of and promptly turn over to the Treasurer all funds of the Society
which come into his hands. He shall provide for the registration of
the members and delegates at the annual sessions. He shall keep a
card-index register of all the legal practitioners of the State by counties,
noting on each his status in relation to his county society. In so far
as it is in his power, he shall use the printed matter, correspondence
and influence of his office to aid the councilors in the organization and
improvement of the county societies, and in the extension of the power
and usefulness of this Society. He shall conduct the ofiicial correspon-
dence, notifying members of meetings, officers of their election, and
committees of their appointment and duties. He shall act as Chair-
man of the Committees on Scientific Work and on Publication. He
shall employ such assistants as may be ordered by the Council or the
House of Delegates. He shall annually make a report of his doings to
the House of Delegates.

In order that the Secretary may be enabled to give tliat amount of
time to his duties which will permit of his becoming proficient, it is
desirable that he should receive some compensation. The amount of his
salary shall be fixed by the House of Delegates.

CHAPTER VII.— Councilor Districts.

Section 1. To facilitate the more perfect oiganization of the medical
profession, the State of North Carolina is hereby divided by counties
into ten councilor districts, as follows:

First District. — Currituck, Camden, Pasquotank, Perquimans, Gates.
Chowan, Washington, Tyrrell, Dare and Hyde.

808 FIFTY-FIFTH ANNUAL SESSION

Second District. — Hertford, Martin, Pitt, Bertie, Beaufort, Lenoir,
Jones, Craven, Pamlico and Carteret.

Third District. — New Hanover, Pender, Onslow, Duplin, Bladen, Samp-
son, Columbus and Brunswick.

Fourth District. — Northampton, Halifax, Nash, Edgecombe, John-
ston, Wilson, Wayne and Greene.

Fifth District. — Cumberland, Robeson, Scotland, Richmond, Mont-
gomery, Moore, Harnett and Chatham.

Sixth District. — Wake, Franklin, Warren, Vance, Granville, Person,
Caswell, Alamance, Orange and Durham.

Seventh District. — Anson, Union, Stanly, Mecklenburg, Cabarrus, Lin-
coln, Gaston, Cleveland and Rutherford.

Eighth District. — Rockingham, Guilford, Randolph, Forsyth, Stokes,
Surry, Yadkin, Alleghany, Wilkes and Ashe.

Ninth District. — Davidson, Davie, Rowan, Iredell, Alexander, Catawba,
Caldwell, Watauga, Mitchell and Burke.

Tenth District. — Buncombe, Yancey, McDowell, Madison, Polk, Hen-
derson, Haywood, Transylvania, Jackson, Swain, Macon, Graham, Clay
and Cherokee.

CHAPTER VIIL— Council.

Section 1. The Council shall hold daily meetings during the annual
session of the Association and at such other times as necessity may
require, subject to the call of the Chairman or on petition oif three
Councilors, It shall meet on the last day of the annual session of the
Association for reorganization and for the outlining of work for the
ensuing year. At this meeting it shall elect a Chairman and Secretary,
and it shall keep a permanent record of its proceedings. It shall,
through its Chairman, make an annual report to the House of Delegates
at such time as may be provided.

Sec. 2. Each Councilor shall be organizer, peacemaker and censor
for his district. He shall visit each county in his district at least once
a year for the purpose of organizing component societies where none
exist, for inqviiring into the condition of the profession, and for im-
proving and increasing the zeal of the county societies and their mem-
bers. He shall make an annual report of his doings, and of the con-
dition of the profession of each county in his district to each annual
session of the House of Delegates. The necessary traveling expenses in-
curred by such Councilor in the line of the duties herein imposed may
be allowed by the House of Delegates upon a proper itemized statement,
but this shall not be construed to include his expense in attending the
annual session of the Society.

Sec. 3. Collectively the Council shall be the Board of Censors of
the Society. It shall consider all questions involving the rights and
standing of members, whether in relation to other members, to the
component societies, or to this Society. All questions of an ethical
nature brouf'ht before the House of Delegates or the general meeting

N. C. MEDICAL SOCIETY. 809

shall be referred to the Council without discussion. It shall hear and
decide all questions of discipline affecting the conduct of members or of
a county society, upon which an appeal is taken from the decision of
an individual councilor. Its decision in all such cases shall be final.

Sec. 4. The Council shall have the right to communicate the views
of the profession and of the Society in regard to health, sanitation and
other important matters to the public and the lay press. Such com-
munications shall be officially signed by the Chairman and Secretary
of the Council, as such.

CHAPTER IX.— Committees.

Section 1. The standing committees shall be as follows:

A Committee on Scientific Work.

A Committee on Public Policy and Legislation.

A Committee on Publication.

A Committee on Nominations.

A Committee on Finance.

A Committee on Obituaries.

A Committee on Arrangements, and such other committees as may be
necessary. Such committees shall be elected by the House of Delegates,
unless otherwise provided.

Sec. 2. The Committee on Scientific Work shall consist of three
members, of which the Secretary shall be a member and Chairman, and
shall determine the character and scope of the scientific proceedings of
the Society for each session, subject to the instructions of the House
of Delegates or of the Society, or to the provisions of the Constitution
and By-laws. Thirty days previous to each annual session it shall
prepare and issue a program announcing the order in which papers,
discussions and other business shall be presented, which shall be ad-
hered to by the Society as nearly as practicable.

Sec. 3. The Committee on Public Policy and Legislation shall con-
sist of three members and the President and Secretary. Under the
direction of the House of Delegates it shall represent the Society in
securing an enforcing legislation in the interest of public health
and of scientific medicine. It shall keep in touch with professional
and public opinion, shall endeavor to shape legislation so as to secure
the best results for the whole people, and shall utilize every organized
influence of the profession to promote the general influence in local.
State and national aft'airs and elections. Its work shall be done with
the dignity becoming a great profession, and with that wisdom which
will make effective its power and influence. It shall have authority
to be heard before the entire Society upon questions of great concern
at such time as may be arranged during the annual session.

Sec. 4. The Committee on Publication shall consist of three members,
of which the Secretary shall be one and Chairman, and shall have re-
ferred to it all reports on scientific subjects, and all scientific papers

810 FIFTY-riFTII ANNUAL SESSION

and eliscussions heard before the Society. It shall be empowered to
curtail or abstract papers and discussions, and any paper referred to
it which may not be suitable for publication in the transactions may be
returned to the author. The committee shall have authority to ar-
range for the publication and distribution of the transactions after
receiving competitive bids, ^and shall use diligence in getting them into
the hands of the members. All papers read before the Society shall be
the property of the Society.

Sec. 5. The Committee on Nominations shall be appointed and per-
form its duties in accordance with the provisions of chapter .5, section
2, of these By-laws.' They shall also nominate an Orator and Essayist,
a Leader of Debate, a Committee on Scientific Work, a Committee on
Public Policy and Legislation, a Committee on Publication, a Com-
mittee on Obituaries, a Committee on Finance, one member of the Com-
mittee of Arrangements, delegates to the American Medical Association,
the Virginia Medical Society, the South Carolina Medical Association,
and to such other bodies as the Society may determine. They shall
also each third year nominate a board of ten councilors.

Sec. 6. The Committee on Finance, to consist of three members, shall
examine the accounts of the Treasurer and report to the Society, making
suggestions as to the amount of assessments for the coming year, the
remuneration of the Secretary and the Treasurer, and such other sug-
gestions concerning the finances of the Society as they may think
proper. The Committee on Obituaries to consist of three members,
shall rejDort to the general meeting of the Society the names of all
members dying during the past year, with other data appropriate for
memorial publication.

Sec. 7. The Committee of Arrangements shall consist of one member
elected by the House of Delegates each year, and two members elected
by the county society in the territory in which the annual session is to
be held. It shall, by committees of its own selection, provide suitable
accommodations for the meeting places of the Society and of the House
of Delegates, the Board of Medical Examiners, and of their respective
committees, and shall have general charge of all the arrangements. Its
Chairman shall report an outline of the arrangements to the Secretary
for publication in the program, and shall make additional announce-
ments during the session as occasion may require.

CHAPTER X. — Of the Sections and Voluntary Communications.

Section 1. The newly-installed President shall, at the last session
of each meeting, appoint a member to serve as Chairman of each of
the following sections, to wit: Anatomy and Surgery, Materia Medica
and Therapeutics, Practice of Medicine, Physiology and Chemistry,
Obstetrics, Gynecology, Medical Jurisprudence and State Medicine,
Pathology and Microscopy, and Railway Surgery.

Sec. 2. At any time after the meeting the Chairman of each section

N. C. MEDICAL SOCIETY. 811

may appoint three such members as he may select as liis assistants to
work up such items as he may designate, confining Iiimself to tlie
general advancement in his section.

Sec. 3. The Chairmen of sections shall send in to the Secretary, not
later than thirty days previous to each meeting of the Society, the
titles of papers to be presented by themselves and their assistants, to
be used by the Committee on Scientific Work in making a program
for the meeting.

Sec. 4. No paper shall be read before the Society unless the author
be present, unless his absence be due to some unavoidable circumstance.
A paper jjresented by proxy may be referred to the Committee on
Publication.

Sec. 5. No paper shall be referred to the Committee on Publication
until it has been placed in the hands of the Secretary; and the Secre-
tary shall not return any paper accepted by the Society without the
consent of the Society, and then he shall take a receipt for the same.

Sec. 6. No paper shall be received by or read before this Society
that has been presented to any other society, excepting only a com-
ponent society of this Society, or that has been offered for publication
in any journal ; and in the case of any paper accepted the author is
supposed to have invested with the Society all rights to its ownership.

Sec. 7. No paper shall be published in the transactions of this
Society unless approved by the Committee on Publication ; and any
paper rejected by said committee shall be returned to the author through
the Secretary of the Society.

Sec. 8. It is to be understood that the Society is not to be considered
as endorsing all the views and opinions advanced bj' the authors of
papers published in the transactions of the Society.

CHAPTER XI. — Assessments and Expenditures.

Section 1. An assessment of two dollars per capita on the member-
ship of the component societies is hereby made the annual dues of this
Society, which amount shall be collected by the Secretary of each county
society, from each of its members, on or before the first day of March,
and forwarded to the Treasurer of the State Society before the first
day of April in each year. The secretary of each county society shall
forward a statement of its assessment, together with its roster of all
officers and members, list of delegates and list of nonaffiliated physicians
of the county, to the Secretary of this Society on or before the first
day of April in each year.

Sec. 2. Any county society which fails to pay its assessment, or
make the reports required, on or before the date above stated, shall
be held as suspended, and none of its members or delegates shall be
permitted to participate in any of the business or proceedings of the
State Society, or of the House of Delegates, or receive the volume of
transactions, until such requirements have been met.

812 FIFTY-FIFTH ANNUAL SESSION

Sec. 3. All motions or resolutions appropriating money shall specify
a definite amount, or so much thereof as may be necessary for the pur-
pose indicated, and must be approved by the Council and House of
Delegates on a call of the ayes and noes.

CHAPTER XII.— Rules of Conduct.

The principles set forth in the Declaration of Principles of Medical
Ethics of the American Medical Association shall govern the conduct
of members in their relations to each other and to the public.

CHAPTER XIII.— Rules of Order.

The deliberations of this Society shall be governed by parliamentary
usage as contained in Robert's Rules of Order, unless otherwise deter-
mined by a vote of its respective bodies.

CHAPTER XIV.— County Societies.

Section 1. AH county societies now in affiliation with the State
Society, or those that may hereafter be organized in this State, which
have adopted principles of organization not in conflict with this Con-
stitution and By-laws, shall, upon application to the House of Dele-
gates, receive a charter from and become a component part of this
Society.

Sec. 2. As rapidly as can be done after the adoption of this Con-
stitution and By-laws, a medical society shall be organized in every
county in the State in which no component society exists, and charters
shall be issued thereto.

Sec. 3. Charters shall be issued only upon approval of the House
of Delegates, and shall be signed by the President and Secretary of
this Society. The House of Delegates shall have authority to revoke
the charter of any component county society whose actions are in con-
flict with the letter or spirit of this Constitution and By-laws.

Sec. 4. Only one component medical society shall be chartered in
any county. Where more than one county society exists, friendly over-
tures and concessions shall be made, with the aid of the Councilor for
the district, if necessary, and all of the members brought into one
organization. In case of failure to unite, an appeal may be made to
the Council, which shall decide what action shall be taken.

Sec. 5. Each county society shall judge of the qualification of its
own members, but, as such societies are the only portals to this Society
and to the American Medical Association, every reputable and legally
registered physician who is practicing, or who will agree to practice
nonsectarian medicine, shall be entitled to membership. Before a charter
is issued to any county society, full and ample notice and opportunity
shall be given to every such physician in the county to become a mem-
ber.

Sec. 6. Any physician who may feel aggrieved by the action of the
society of his county in refusing him membership, or in suspending

N. C. MEDICAL SOCIETY. 813

or expelling him, shall have the right of appeal to the Council, and to
the House of Delegates.

Sec. 7. In hearing appeals the Council may admit oral or written
evidence, as in its judgment will best and most fairly present the facts,
but in case of every appeal, both as a board and as individual council-
ors in district and county work, efforts at conciliation and compromise
shall precede all such hearings.

Sec. 8. When a member in good standing in a component society
moves to another county in this State, his name, upon request, shall
be transferred without cost to the roster of the county society into
whose jurisdiction he moves.

Sec. 9. A physician living on or near a county line may hold his
membership in that county most convenient for him to attend, on per-
mission of the society in whose jurisdiction he resides.

Sec. 10. Each county society shall have general direction of the
affairs of the profession in the county, and its influence shall be con-
stantly exerted for bettering the scientific, moral and material con-
dition of every physician in the county; and systematic efforts shall
be made by each member, and by the society as a whole, to increase
the membership until it embraces every qualified physician in the
county.

Sec. 11. Frequent meetings shall be encouraged, and the most at-
tractive programs arranged that are possible. The younger mem-
bers shall be especially encouraged to do post-graduate and original
research work, and to give the society the first benefit of such labors.
Official position and other preferments shall be unstintingly given to
such members.

Sec. 12. At some meeting in advance of the annual session of this
Society prior to the first day of April, each county society shall elect
a delegate or delegates with alternates, to represent it in the House
of Delegates of this Society in the proportion of one delegate to each
twenty-five members or major fraction thereof, and the secretary of
the society shall send a list of such delegates with alternates to the
Secretary of this Society at least ten days before the annual sessions.

Sec. 13. The secretary of each county society shall keep a roster of
its members, and a list of the nonaffiliated registered physicians of the
county, in which shall be shown the full name, address, college, and
date of graduation, date of license to practice in this State, and such
other information as may be deemed necessary. He shall furnish an
official report containing such information, upon blanks supplied him
for the purpose, to the Secretary of this Society before the first day
of April, in each year, and at the same time that the dues accruing
from the annual assessment are sent in. In keeping such roster, the
secretary shall note any changes in the personnel of the profession by
death, or by removal to or from the county, and in making his annual
report he shall be certain to account for every physician who has lived
in the county during the year.

814 yiKTY-FIFTir ANNUAL, SESSION

CHAPTER XV.— Order of Business.

Section 1. General Meetings.

The President, or, in his absence, one of the Vice-Presidents in the
order of their rank, shall call the Society to order, or in the absence
of all these officers, a presiding officer shall be chosen by a majority
of the members pre&ent.

Address of Welcome. Response.

Any business requiring early attention may be introduced by per-
mission and without discussion referred to the Council, the House of
Delegates, or the appropriate committee.

The President's Address.

Reports of Committees.

Reports from the House of Delegates.

Reports from the Council.

Written communications upon medical subjects may be read and
discussed. This shall include reports from sections as arranged each
year by the program.

The Annual Oration.

The Annual Essay.

The Annual Debate.

Oral Communications and Clinical Reports read and discussed.

Final Reports from the Council.

Final Reports from the House of Delegates.

Final Reports from Committees.

Report to the General Meeting from the House of Delegates appoint-
ing the time and place of next session.

Report from the House of Delegates of the Election of Officers and
Committees.

Appointment of Chairmen of Sections by President.

Adjournment.

Sec. 2. The House of Delegates.

The President, or, in his absence, one of the Vice-Presidents in the
order of their rank, shall call the Society to order, or in the absence
of all these officers a presiding officer shall be chosen by a majority of
the members present.

Roll-call.

The President's Message.

Report of Committee on Credentials.

Reports of Committees.

Reports of Officers.

Reports of the Council.

Communications from the General Meeting of the Society.

Reports from the County Societies.

Appointment of Committee on Nominations.

New business.

General Discussion of Measures for the Advancement of the Pro-
fession.

N. C. MEDICAL SOCIETY. 815

Reports of Committees.

Election of Officers and Committees.

Selection of Place and Time of Next Meeting.

Unfinished Business.

Adjournment.

(While there may at times appropriately be a variation from the
details of the above outline of business procedure, it is the intention
of these By-laws to so arrange that the work other than the purely
scientific part of the Society's proceedings be done in the Council and
House of Delegates, and the general meetings of the Society be devoted
exclusively to scientific work.)

CHAPTER XVI.— Amendments.

These By-laws may be amended at any annual session by a majority
vote of all the delegates present at that session, after the amendment
has lain upon the table for one day.

(Extract from the proceedings of the American Medical Associa-
tion at the annual session in New Orleans May, 1903.)

Report of the Committee on Medical Ethics.

Dr. E. Eliot Harris, New York, read the following report :

To the President and Memhers of the House of Delegates of the American
Medical Association:

Your enlarged Committee on Medical Ethics, consisting of the Special
Committee, and one delegate from each State, have unanimously adopted
the following report, entitled the "Principles of Medical Ethics of the
American Medical Association," which is herewith submitted.

The following report of the Special Committee shall be printed as
an explanatory preface to the Principles of Medical Ethics of the Ameri-
can Medical Association:

Gentlemen. — Your committee has given extended and careful thought
to the proposed revision of the Code of Medical Ethics referred to it
for consideration. As you will note on reference to the caption of the
report the word "Code" has been eliminated, and the expression "Prin-
ciples of Medical Ethics of the American Medical Association" adopted
as adequately descriptive. In reference to this change, it is proper to
say that such action on its part is based on the idea that the American
Medical Association may be conceived to occupy some such relation
to the constituent State associations as the United States, through its
Constitution, holds to the several States. The committee, for this leuson,
regards it as wiser to formulate the principles of medical ethics with-
out definite reference to "Code" or penalties, thus leaving the respective

816 FIFTY-FIFTH ANNUAL SESSION

States to form such Code, and establish such rules as they may regard
to be fitting and proper, for regulating the professional conduct of
their members, provided, of course, that in doing so there shall be no
infringement on the established ethical principles of this Association.
The committee regard as wise and well intended to facilitate the busi-
ness of the parent, or organization, and promote its harmony, this
course which leaves to the State Association large discretionary powers
concerning membership and other admittedly State affairs. Your com-
mittee has retained, to a large extent, the phraseology of the existing
Code, while aiming at condensation of expression and a better under-
standing of some of its statements. The report of the committee has
been reached unanimously, without dissension or distrust on the part
of its members, each aiming to formulate a result based on principle
alone, and without regard to any past or present disagreements or mis-
understandings whatsoever; such being the case, the committee in-
vites your candid and unprejudiced attention to the results of its labor,
feeling that at least some good has been accomplished.
Respectfully submitted,

E. Eliot Harris, Chairman,
William H. Welch,
T. J. Happel,
Joseph D. Bryant.

The report of the committee was unanimously adopted.

CHAPTER XII.— RULES OF CONDUCT.

"The principles set forth in the Declaration of Principles of Medical
Ethics of the American Medical Association shall govern the conduct
of members in their relations to each other and to the public." — Con-
stitution and By-laws Medical Society of the State of North Carolina,
adopted at Hot Springs, N. C, June 2, 1903.

Principles of Medical Ethics.

(Adopted at the annual session in New Orleans, May, 1903.)

The American Medical Association promulgates as a suggestive and
advisory document, the following:

CHAPTER I. — The Duties of Physicians to Their Patients.

Section 1. Physicians should not only be ever ready to obey the
calls of the sick and the injured, but should be mindful of the high
character of their mission and of the responsibilities they must incur
in the discharge of momentous duties. In their ministrations they
should never forget that the comfort, the health, and the lives of those

X. C. MEDICAL SOCIETY. 817

entrusted to their care, depend on skill, attention and fidelity. In
deportment they should unite tenderness, cheerfulness and firmness, and
thus inspire all sufl"erers with gratitude, respect and confidence. These
observances are the more sacied because, generally, the only tribunal to
adjudge penalties for unkindness, carelessness or neglect is their own
conscience.

Sec. 2. Every patient committed to the charge of a physician should
be treated with attention and humanity, and reasonable indulgence
should be granted to the caprices of the sick. Secrecy and delicacy
should be strictly observed ; and the familiar and confidential inter-
course to which physicians are admitted, in their professional visits,
should be guarded with the most scrupulous fidelity and honor.

Sec. 3. The obligation of secrecy extends beyond the period of pro-
fessional services; none of the privacies of individual or domestic life,
no infirmity of disposition, or flaw of character observed during medi-
cal attendance should ever be divulged by physicians, except when im-
peratively required by the laws of the State. The force of the obligation
of secrecy is so great that physicians have been protected in its observ-
ance by courts of justice.

Sec. 4. Frequent visits to the sick are often requisite, since they
enable the physician to arrive at a more perfect knowledge of the dis-
ease, and to meet promptly every change which may occur. Unneces-
sary visits are to be avoided, as they give undue anxiety to the patient;
but to secure the patient against irritating suspense and disappoint-
ment the regular and periodical visits of the physician should be made
as nearly as possible at the hour when they may be reasonably ex-
pected by the patient.

Sec. 5. Ordinarily, the physician should not be forward to make
gloomy prognostications, but should not fail, on proper occasions, to
give timely notice of dangerous manifestations to the friends of the
patient, and even to the patient, if absolutely necessary. This notice,
however, is at times so peculiarly alarming when given by the physician
that its deliverance may often be preferably assigned to another person
of good judgment.

Sec. 6. The physician should be a minister of hope and comfort to
the sick, since life may be lengthened or shortened not only by the
acts but by the words or manner of the physician, whose solemn duty
is to avoid all utterances and actions having a tendency to discourage
and depress the patient.

Sec. 7. The medical attendant ought not to abandon a patient be-
cause deemed incurable, for continued attention may be highly useful
to the sufferer and comforting to the relatives, even in the last period
of the fatal malady by alleviating pain and by soothing mental anguish.

Sec. 8. The opportunity which a physician has of promoting and
strengthening the good resolutions of patients suffering under the con- '
sequences of evil conduct ought never to be neglected. Good counsels,

818 FIFTY-FIFTH ANNUAL, SESSION

or even remonstrances, will give satisfaction, not offense, if they be
tactfully proffered and evince a genuine love of virtue, accompanied by
a sincere interest in the welfare of the person to whom they are ad-
dressed.

CHAPTER II. — The Duties of Physicians to Each Other and to
THE Profession at Large.

article I. — duties for the support of professional character.

Section 1. Every one, on entering the profession, and thereby be-
coming entitled to full professional fellowship, incurs an obligation to
uphold its dignity and honor, to exalt its standing and to extend the
bounds of its usefulness. It is inconsistent with the principles of
medical science and it is incompatible with honorable standing in the
profession for physicians to designate their practice as based on an ex-
clusive dogma, or a sectarian system of medicine.

Sec. 2. The physician should observe strictly such laws as are
instituted for the government of the members of the profession; should
honor the fraternity as a body; should endeavor to promote the science
and art of medicine, and should entertain a due respect for those
seniors who, by their labors, have contributed to its advancement.

Sec. 3. Every physician should identify himself with the organized
body of his profession as represented in the community in which he
resides. The organization of local or county medical societies, where
they do not exist, should be effected, so far as practicable. Such county
societies, constituting as they do, the chief element of strength in the
organization of the profession, should have the active support of their
members, and should be made instruments for the cultivation of fel-
lowship, for the exchange of professional experience, for the advance-
ment of medical knowledge, for the maintenance of ethical standards,
and for the promotion in general of the interests of the profession and
the welfare of the public.

Sec. 4. All county medical societies thus organized ought to place
themselves in affiliation with their respective State associations, and
these, in turn, with the American Medical Association.

Sec. 5. There is no profession from the members of which greater
purity of character and a higher standard of moral excellence are re-
quired than the medical ; and to attain such eminence is a duty every
physician owes alike to the profession and to patients. It is due to
the patients, as without it their respect and confidence can not be com-
manded, and to the profession because no scientific attainments can
compensate for the want of correct moral principles.

Sec. 6. It is incumbent on physicians to be temperate in all things,
for the practice of medicine requires the unremitting exercise of a
clear and vigorous understanding; and in emergencies — for which no
physician should be unprepared — a steady hand, an acute eye, and an

N. C. MEDICAL SOCIETY. 819

unclouded mind are essential to the welfare and even to the life of a
human being.

Sec. 7. It is incompatible with honorable standing in the profession
to resort to public advertisements or private cards, inviting the at-
tention of the persons affected with particular diseases; to promise
radical cures; to publish cases of operations in the daily prints, or to
suffer such publications to be made; to invite laymen (other than rela-
tives who may desire to be at hand) to be present at operations; to
boast of cures and remedies; to adduce certificates of skill and success,
or to employ any of the other methods of charlatans.

Sec. 8. It is equally derogatory to professional character for phy-
sicians to hold patents for any surgical instruments or medicines; to
accept rebates on prescriptions or surgical appliances; to assist un-
qualified persons to evade the legal restrictions governing the practice
of medicine ; or to dispense, or promote the use of secret medicines, for
if such nostrums are of real efficacj\ any concealment regarding them
is inconsistent with beneficence and professional liberality, and if
mystery alone give them public notoriety, such craft implies either
disgraceful ignorance or fraudulent avarice. It is highly reprehensible
for physicians to give certificates attesting the efficacy of secret medi-
cines or other substances used therapeutically.

ARTICLE II. — PROFESSIONAL SERVICES OF PHYSICIANS TO EACH OTHER-

Section 1. Physicians should not, as a general rule, undertake the
treatment of themselves, nor of members of their family. In such
circumstances, they are peculiarly dependent on each other ; therefore,
kind offices and professional aid should always be cheerfully and gratu-
itously afforded. These visits ought not, however, to be obtrusively
made, as they may give rise to embarrassment, or interfere with that
free choice on which such confidence depends.

Sec. 2. All practicing physicians and their immediate family de-
pendents are entitled to the gratuitous services of any one or more of
the physicians residing near them.

Sec. 3. When a physician is summoned from a distance to the bed-
side of a colleague in easy financial circumstances, a compensation,
proportionate to traveling expenses and to the pecuniary loss entailed
by absence from the accustomed field of professional labor, should be
made by the patient or relatives.

Sec. 4. When more than one physician is attending another, one of
the number should take charge of the case, otherwise the concert of
thought and action so essential to wise treatment can not be assured.

Sec. 5. The affairs of life, the pursuit of health and .the various
accidents and contingencies to which a physician is peculiarly exposed,
sometimes require the temporary withdrawal of this physician from
daily professional labor, and the appointment of a colleague to act
for a specified time. The colleague's compliance is an act of courtesy

820 FIFTY-FIFTH ANNUAL SESSION

which should always be performed with the utmost consideration for
the interest and character of the family physician.

ARTICLE III. THE DUTIES OF PHYSICIANS IN REGARD TO CONSULTATIONS.

Section 1. The broadest dictates of humanity should be obeyed by
physicians whenever and wherever their services are needed to meet
the emergencies of disease or accident.

Sec. 2. Consultations should be promoted in difficult cases, as they
contribute to confidence and more enlarged views of practice.

Sec. 3. The utmost punctuality should be observed in the visits of
physicians when they are to hold consultations, and this is generall}^
practicable, for society has been so considerate as to allow the plea
of a professional engagement to take precedence over all others.

Sec. 4. As professional engagements may sometimes cause delay in
attendance, the physician who first arrives should wait for a reasonable
time, after which the consultation should be considered as postponed
to a new appointment.

Sec. 5. In consultations no insincerity, rivalry, or envy should be
indulged in ; candor, probity, and all due respect should be observed
toward the physician in charge of the case.

Sec. G. No statement or discussion of the case should take place be-
fore the patient or friends, except in the presence of all the physicians
attending, or by their common consent; and no opinions or prognostica-
tions should be delivered which were not the result of previous delibera-
tion and concurrence.

Sec. 7. No decision should restrain the attending physician from
making such consequent variations in the mode of treatment as any
unexpected change in tlie character of the case may demand. But at
the next consultation reasons for the variations should be stated. The
same privilege, with its obligation, belongs to the consultant when sent
for in an emergency during the absence of the family physician.

Sec. 8. The attending physician at any time may prescribe for the
patient; not so the consultant, when alone, except in a case of emergency
or when called from a considerable distance. In the first instance the
consultant should do what is needed, and in the second, should do no
more than make an examination of the patient, and leave a written
opinion, under seal, to be delivered to the attending physician.

Sec. 9. All discussions in consultation should be held as confidential.
Neither by words nor by manner should any of the participants in a
consultation assert, or intimate, that any part of the treatment pur-
sued did not receive his assent.

Sec. 10. It may happen that two physicians can not agree in their
views of the nature of a case and of the treatment to be pursued. In
the event of such disagreement a third physician should, if practicable,
be called in. None but the rarest and most exceptional circumstances
would justify the consultant in taking charge of the case. He should
not do so merely on the solicitation of the patient or friends.

N. C. MEDICAL SOCIETY. 821

Sec. 11. A physician who is called in consultation, should observe the
most honorable and scrupulous regard for the character and standing
of the attending physician, whose conduct of the case should be ju^^tified,
as far as can be, consistently with the conscientious regard for truth,
and no hint or insinuation should be thrown out which could impair
the confidence reposed in the attending physician.

ARTICLE IV. DUTIES OF PHYSICIANS IX CASES OF INTERFERENCE.

Section 1. INIedicine being a liberal profession, those admitted to
its ranks should found their expectations of practice especially on the
character and the extent of their medical education.

Sec 2. The physician, in his intercourse with a patient under the
care of another physician, should observe the strictest caution and
reserve ; should give no disingenuous hints relative to the nature and
treatment of the patient's disorder, nor should the course of conduct
of the physician, directly or indirectly, tend to diminish the trust re-
posed in the attending physician.

Sec 3. The same circumspection should be observed when, from
motives of business or friendship, a physician is prompted to visit a
person who is under the direction of another physician. Indeed, such
visits should be avoided, except under peculiar circumstances ; and
when they are made, no inquiries should be instituted relative to the
nature of the disease, or the remedies employed, but the topics of con-
versation should be as foreign to the case as circumstances will admit.

Sec 4. A physician ought not to take charge of, or prescribe for
a patient who has recently been under the care of another physician,
in the same illness, except in case of a sudden emergency, or in con-
sultation with the physician previously in attendance, or when that
physician has relinquished the case or has been dismissed in due form.

Sec. 5. The physician acting in conformity with the preceding sec-
tion should not make damaging insinuations regarding the practice
previously adopted, and indeed, should justify it if consistent with truth
and probity; for ,it often happens that patients become dissatisfied
when they are not immediately relieved, and, as many diseases are
naturally protracted, the seeming want of success, in the first stage
of treatment, affords no evidence of a lack of professional knowledge
and skill.

Sec. G. When a physician is called to an urgent case, because the
family attendant is not at hand, unless assistance in consultation is
desired, the former should resign the care of the patient immediately
on the arrival of the family physician.

Sec. 7. It often happens, in cases of sudden illness, and of accidents
and injuries, owing to the alarm and anxiety of friends, that several
physicians are simultaneously summoned. Under these circumstances,
courtesy should assign the patient to the first who arrives, and who,
if necessary, may invoke the aid of some of those present. In such

822 FIFTY-FIFTH ANNUAL, SESSION

a case, however, the acting physician should request that the family
physician be called, and should withdraw unless requested to continue
in attendance.

Sec. 8. Whenever a physician is called to the patient of another
physician during the enforced absence of that physician, the case
should be relinquished on the return of the latter.

Sec. 9. A physician while visiting a sick person in the country,
may be asked to see another physician's patient because of a sudden ag-
gravation of the disease. On such an occasion the immediate needs
of the patient should be attended to and the case relinquished on the
arrival of the attending physician.

Seo. 10. When a physician who has been engaged to attend an
obstetric case is absent, and another is sent for, delivery being ac-
complished during the vicarious attendance, the acting physician is
entitled to the professional fee, but must resign the patient on the
arrival of the physician first engaged.

ARTICLE V DIFFERENCES BETWEEN PHYSICIANS.

Section 1. Diversity of opinion and opposition of interest may, in
the medical as in other professions, sometimes < occasion controversy and
even contention. Whenever such unfortunate cases occur and can not
be immediately adjusted, they should be referred to the arbitration of
a sufficient number of impartial physicians.

Sec. 2. A peculiar reserve must be maintained by physicians toward
the public in regard to some professional questions, and as there exist
many points in medical ethics and etiquette through which the feelings
of physicians may be painfully assailed in their intercourse, and which
can not be understood or appreciated by general society, neither
the subject-matter of their differences nor the adjudication of the
arbitrators should be made public.

article VI. — compensation.

Section 1. By the members of no profession are eleemosynary services
more liberally dispensed than by the medical, but justice requiies that
some limits should be placed to their performance. Poverty, mutual
professional obligations and certain of the public duties named in
sections 1 and 2 of chapter III, should always be recognized as piesent-
ing valid claims for gratuitous services; but neither institutions en-
dowed by the public or by the rich, or by societies .for mutual benefit,
for life insurance, or for analogous purposes, nor any profession or
occupation can 'be admitted to possess such privilege.

Sec. 2. It can not be justly expected of physicians to furnish cer-
tificates of inability to serve on juries, or to perform militia 'duty;
to testify to the state of health of persons wishing to insure their lives,
obtain pensions, or the like, without due compensation. But to persons
in indigent circumstances such services should always be cheerfully
and freely accorded.

N. C. MKDICAL SOCIETY. 823

Sec. 3. Some general rules should be adopted by the physicians in
every town or district relative to the minimum pecuniary acknowledg-
ment from their patients ; and it should be deemed a point of honor to
adhere to these rules with as much uniformity as varying circmnstances
will admit.

Sec. 4. It is derogatory to professional character for physicians to
pay or offer to pay commissions to any person whatsoever, who may
recommend to them patients requiring general or special tieatment or
surgical operations. It is equally derogatory to professitmal character
for physicians to solicit or to receive such commissions.

CHAPTER III. — The Duties of the Profession to the Public.

Section I. As good citizens it is the duty of physicians to be very
vigilant for the welfare of the community, and to bear their part in
sustaining its laws, institutions and burdens; especially should they
be ready to cooperate with the proper authorities in the administration,
and the observance of sanitary laws and regulations, and they should
also be ever ready to give counsel to the public in relation to subjects,
especially appertaining to their profession, as on questions of sanitary
police, public hygiene and legal medicine.

Sec. 2. It is the province of physicians to enlighten the public in
regard to quarantine regulations; to the location, arrangement and
dietaries of hospitals, asylums, schools, prisons and similar institutions;
in regard to measures for the prevention of epidemic and contagious
diseases; and when pestilence prevails, it is their duty to face the
danger and to continue their labors for the alleviation of the suffering
people, even at the risk of their own lives.

Sec. 3. Physicians when 'called on by legally constituted authorities,
should always be ready to enlighten inquests and courts of justice on
subjects strictly medical, such as involve questions relating to sanity,
legitimacy, murder by poison, or other violent means, and various other
subjects embraced in the science of medical jurisprudence. It is but
just, however, for them to expect due compensation for their s-ervices.

Sec. 4. It is the duty of physicians, who are frequent witnesses of
the great wrongs committed by charlatans, and of the injury to health
and even destruction of life caused by the use of their treatment, to
enlighten the public on these subjects, and to make known the injuries
sustained by the unwary from the devices and pretensions of artful
impostors.

Sec. 5. It is the duty of physicians to recognize, and by legitimate
patronage to promote the ■ profession of pharmacy, on the skill and
proficiency of which depends the reliability of remedies, but any phar-
macist who, although educated in his own profession, is not a qualified
physician, and who assumes to prescribe for the sick, ought not to
receive such countenance and support. Any druggist or pharmacist
who dispenses deteriorated or sophisticated drugs, or who substitutes
one remedy for another designated in a prescription, ought thereby
to forfeit tlie recognition and influence of physicians.

824 FIFTY-FIFTH ANNUAL -SESSION

CONSTITUTION AND BY-LAWS

FOR

COUNTY MEDICAL SOCIETIES.

(Approved by the Medical Society of the State of North Carolina at
the annual session in Hot Springs, N. C, June 2, 1903.)

Introductory.

The Committee on Organization of the American Medical Association,
which was continued at the Saratoga meeting, herewith submits a
tentative Constitution and By-laws for county societies, and in doing
so desires to say, that while the provisions it contains are deemed
essential to good organization, some of the provisions are suggestive
and educational in character and may not be applicable to every county
or section. In such cases these may be omitted, or others more apprO'
priate substituted for them. In any event, the high ideals for the
individual physician, and the spirit of courtesy and kindness which
should govern him in his dealings with his professional neighbors, are
here set forth for tliought and consideration.

The Committee is not a unit as to whether there should be charged
an admission fee as called for in section 1, chapter V, of the By-laws,
but the majority of the committee believes that this is the correct
principle, for the average individual does not appreciate that which he
gets for nothing, and furthermore, that if an admission fee ,is cliarged
the individual will not be as likely to drop out of the Society, as if he
obtained his membership for nothing. Tlie committee advises, however,
that in organizing a County Society, or before adopting the new Con-
stitution, that the charter shall be, open for all in the county who are
eligible and admit such charter members without tlie admission fee.

We close this report by making a quotation from our report when
we submitted the Constitution and By-laws for State societies :

Much in the Bj'-laws submitted maj^ be regarded as "preaching,"
but it is inserted advisedly, with the sole object of arousing in the
minds of each Medical Society member a desire for the accomplishment
of greater ends than has been permitted by the customs and forms of
the past. The committee earnestly desires that the State committees
will continue the work of perfecting organization, actuated by that love
for our profession .that its ideals demand. With the medical profession
well organized, medical science will more rapidly step to its appointed
high place, and the profession which lives in its atmosphere will have
that power and respect in the commvuiity that is its riglit.

J. N. McCoRMACK, Bowling Green, ,Ky.,
P. Maxwell Fosiiay, Cleveland, Ohio,
George H. Simmons, Chicago, Illinois,

Committee.

N. C. MEDICAL SOCIETY. 82i

Constitution.

Article I. — Name and Titi-^ of the Society.

The name and title of this organization shall be the County

Medical Society.

Article II. — Purposes of the Society.

The purpose of this Society shall be to bring into one organization

the physicians of County ; so that by frequent meetings and

full and frank interchange of views they may secure such intelligent
unity and harmony in every phase of their labor as will elevate and
make effective the opinions of the profession in all scientific, legislative,
public health, material and social affairs, to the end that the profession
may receive that respect and support within its own ranks and from the
community to which its honorable history and great achievements
entitle it; and with other county societies to form the Medical Society
of the State of North Carolina, and through it, with other State associa-
tions, to form and maintain the American Medical Association.

Article III. — Eligibility.

Every legally registered physician residing and practicing in

County, who is of good moral and professional standing and who does
not practice or claim to practice sectarian medicine, shall be eligible
for membership.

Article VI. — Meetings.

Regular meetings shall be held at such time and place as may be
determined by the Society. Special meetings may be called by the
President on a written request of five members. Calls for special
meetings shall state the object of such meeting, and no business except
that stated in the call shall be transacted at such meeting.

Article V.

The officers of this Society shall consist of a President, Vice-President,
Secretary, Treasurer, Delegates, and Board of (three) Censors. These
officers, except the Delegates and Board of Censors, shall be elected annu-
ally for a term of one year. Delegates shall be elected for two years, or
in accordance with the Constitution and By-laws of the State Associa-
tion. One member of the Board of Censors shall be elected each year to
serve for three years, provided that at the first election after the
adoption of this Constitution one member of the board shall be elected
for one, one for two and one for three years.

Article VI. — Funds and Expenses.

Funds for meeting the expenses of the Society shall be raised by
admission fee, annual dues, special assessments and voluntary contri-

826 FIFTY-FIFTH ANNUAL, SESSION

bution. Funds may be appropriated by vote of the Society for such
purposes as will promote its welfare and that of the profession.

Article VII. — Charter.

The Society shall apply to the State Society for a charter at the
meeting at which this Constitution and By-laws are adopted, or as soon
thereafter as practicable, and the charter shall be kept in the custody
of the Secretary.

Article VIII. — Incorporation.

The Society shall have authority to appoint a Board of Trustees
and to provide for articles of incorporation whenever it may deem the
same necessary.

Article IX. — Amendments.

The Society may amend any article of this Constitution by a two-
thirds vote of its members at any regular meeting, provided that such
amendment shall have been read in open session at a previous regular
meeting and shall have been sent by mail to each member ten days in
advance of the meeting at which final action is to be taken.

By-laws.

Chapter I. — Membership.

Section 1. The Society shall judge of the qualification of its mem-
bers, but as it is the only door to the State Medical Society and to the
American Medical Association for physicians within its jurisdiction,

every reputable and legally qualified physician in County,

who does not practice or claim to practice sectarian medicine, shall be
entitled to membership.

Sec. 2. A candidate for membership shall make application in writ-
ing, and shall state his age, his college, and date of graduation, the
place in which he has practiced, and the date of registration in this
State. The application must be accompanied by the admission fee, and
must be endorsed by two members of this Society. It shall be referred
to the Board of Censors, who shall inquire into the standing of the
applicant, assure themselves that he or she is duly registered according
to the laws of the State, and report at the next regular meeting of this
Society. Election shall be by ballot, and two-thirds of the votes of the
members present and voting shall be necessary to elect. The application
shall be returned to the Secretary, who shall file it for future reference.
Applications for membership from rejected candidates shall not be
received within six months of such rejection.

Sec. 3. A physician accompanying his application with a transfer
card from another component county society of this or any State within

N. C. MEDICAL SOCIETY. 827

sixty days of the issuance of said card, may be admitted without fee
on a majority vote of the members present, and without the application
being referred to the Board of Censors. Such applications may be acted
on at the meeting at which they are presented on the vote of three-
fourths of the members present, otherwise they shall lie over imtil the
next regular meeting. No annual dues for the current yeai- shall be
charged against such members, provided the same have been paid to
the society from which the applicant comes.

Sec. 4. A physician residing in an inuncdiately adjoining county
may become a member of this Society in like manner and on the same
terms as a physician living in this countj', on permission of the county
society of the county in which the applicant lives, if there be one,
or of the State Councilor for this jurisdiction.

Sec. 5. A member in good standing who is free from all indebtedness
to this Society, and against whom no charges are pending, wishing
to withdraw, shall be granted a transfer card. This card shall state
the date the member associated himself with this Society, the date of
issuance of the card, and shall be signed bj' the President and Secretary,
It shall be accompanied with a copy of the application presented at the
time the member joined the Society, for information to the society to
which the member desires to attach himself.

Sec. 6. All members shall be equally privileged to attend all meet-
ings and take part in all proceedings, and shall be eligible to any
office or honor within the gift of the Society, so long as they conform
to this Constitution and By-laws, including the payment of the dues to
this Society and to the State Association: Provided, that no member
under sentence of expulsion shall take part in any of the proceedings,
or be eligible to any office until relieved of such disability. And pro-
vided further, that none of the privileges of membership shall be ex-
tended to any person not a member of this Society, except on a
majority vote of the Society in regular meeting.

Sec. 7. A member who is guilty of a criminal offense or of gross mis-
conduct, either as a physician or as a citizen, or who violates any of the
provisions of this Constitution and By-laws, shall be liable to censure,
suspension or expulsion. Charges against a member must be made in
writing and be delivered to the Secretary, who shall immediately
furnish a copy to the accused and to the Chairman of the Board of
Censors. The Board of Censors shall investigate the charges on their
merits, but no action shall be taken by the board before giving the
accused and accusers ample opportunity to be heard. Nor shall any
action be taken by the board within ten days of the presentation of
the charges to the accused. The board shall report ( 1 ) that the charges
are not sustained; or (2) that the charges are sustained, and that the
accused be (a) censured; (b) suspended for a definite time, or (c)
expelled. Censure or suspension shall require a two-thirds vote of
the members present and voting, and a three-fourths vote of those
present and voting shall be required to expel a member. No action

828 FIFTY-FIFTH ANNUAL SESSION

shall be taken by the Society in such cases until at least six weeks have
elapsed since the filing of the charges. A member suspended for a
definite time shall be reinstated at the expiration of the time, without
action on his part or on the part of the Society.

Sec. 8. Kindly efforts in the interest of peace, conciliation or refor-
mation, so far as possible and expedient, shall precede the filing of
formal charges affecting the character or standing of a member, and
the accused shall have opportunity to be heard in his own defense in
all trials and proceedings of this nature.

Sec. 9. Members expelled from this Society for any cause shall be
eligible for membership after one year from date of expulsion, and
on the same terms and in like manner as original applicants.

Chapter II. — Poweus and Duties.

Section I. This Society shall have general direction of the affairs
of the medical profession of the covmty, and its influence shall be
constantly exerted to better the scientific, material and social condition
of every physician within its jurisdiction. Systematic efforts shall be
made by each member, and by the Society as a whole, to increase the
membership until it embraces every reputable physician in the county.

Sec. 2. A meeting shall be held at.... p. m. on the in each

month (or oftener) members shall constitute a quorum. The

oflicers and committee on program shall profit by experience and by the
example of other silmiar societies, and strive to arrange for the most
attractive and successful proceedings for each meeting. Younger mem-
bers especially shall be encouraged to do post-graduate and original
research work, and to give this Society the first results of such labors.
Crisp papers and discussions and reports of cases shall be arranged
for and encouraged, and tedious and profitless proceedings and dis-
cussions shall be avoided as far as practicable.

Sec. 3. One meeting during each year maj' be set apart for a dis-
cussion of the business affairs of the profession of the county, with
the view of adopting the best methods for the guidance of all. In all
proper waj's the public shall be taught that business methods and
prompt collections are essential to the equipment of the modern phy-
sician and surgeon, and that it suffers even more than the profession
when this is not recognized.

Sec. 5. The Society shall endeavor to educate its members to the
belief that the physician should be a leader in his community, in
character, in learning, in dignified and manly bearing, and in courteous
and open treatment of his brother physicians, to the end that the
profession may occupy that place in its own and the pviblic estimation
to which it is entitled.

Chapter III. — Officers.

Section 1. The officers of the Society shall be elected at the (Decem-
ber) meeting in each year, which shall be known as the annual meet-

^^ C. MEDICAL SOCIETY. 829

ing. Nominations shall be made by informal ballot, and all elections
shall be by ballot. The vote of a majority of all the members present
shall be necessary to an election.

Sec. 2. The President shall preside at all meetings of the Society,
and perform such other duties as custom and parliamentary usage
maj' require. He shall be the real head of the profession in the county
during the year, and it shall be his pride and ambition to leave it in
better condition as regards both scientific attainments and harmony
than at the beginning of his term of office.

Sec. 3. The Vice-President shall assist the President in the per-
formance of his duties, shall preside in his absence, and. on his death,
resignation or removal from the county, shall succeed to the presidency.

Sec. 4. The Secretary shall record the minutes of the meetings
and receive and care for all records and papers belonging to the So-
ciety, including its charter. He shall keep account of and promptly
turn over to the Treasurer all funds of the Society which may come
into his hands. He shall make and keep a correct list of the mem-
bers of this Society in good standing, noting of each his correct name,
address, place and date of graduation, and the date of the certificate
entitling him to practice medicine ; and in a separate list he shall note
the same facts in regard to each legally qualified physician in this
county not a member of this Society. It shall be his duty to send a
copy of such lists, on blank forms furnished him for that purpose, to
the Secretary of the State Association, at such time as may be desig-
nated by the State Association. In making such lists he shall endeavor
to account for each physician who has moved into or out of the county
during the year, stating, when possible, both his present and past
address. At the same time, and with his report of such lists of mem-
bers and physicians, he shall transmit to the State Association his
order on the Treasurer for the annual dues of the Societj'.

Sec 5. The Treasurer shall receive all dues and money belonging to
the Society from the hands of the Secretary or members, and shall pay
out the same only on the written order of the Secretary.

Sec. 6. The delegates shall attend and faithfully represent the mem-
bers of this Society and the profession of this county in the House of
Delegates of the State Society, and shall make a report of the proceed-
ings of that body to this Society at the earliest opportunity.

Chapter IV. — Committees.

Section 1. There shall be a Board of Censors as provided in the
constitution, a standing committee on programs and scientific work, a
committee on public health and legislation, and such special committees
as may from time to time be deemed necessary.

Sec. 2. Board of Censors. — This board, consisting of three members,
one elected annuallj', shall examine and report on the qualification of
applicants for membership, subjecting each applicant to such exami-

830 laFTY-FIFTII ANNLTxiL SESSION

nation as it may deem necessary. It shall investigate charges preferred
against a member, and report its conclusions and recommendations to
the Society. In case of the absence of a member of the board, the
President may appoint some member to fill the vacancy. The senior
member of the board in point of service shall be chairman of the board.

Sec. 3. Committee on Program and Scientific Work. — This committee
shall consist of the President, Vice-President and Secretary. It shall
be its duty to promote the scientific and social functions of the Society
by arranging attractive programs for each meeting, and by urging each
member to take part in the scientific work. It shall stimulate frater-
nalisra and good fealing among the members in every way possible.

Sec. 4. Committee on Public Health and Legislation. — This committee
shall consist of three members, who shall be appointed annually by the
President. It shall be its duty to enforce and support the sanitary
and medical laws of the State in this county, to cooperate with the
legislative committee of the State Association in all matters pertaining
to legislation, and to prosecute quacks and medical pretenders in this
county.

Chapter V. — Funds and Expenses.

Section 1. The admission fee, which must accompany the application,
shall be $5.00, and shall include the annual dues for the fiscal year,
provided that when more than one-half of the fiscal year has elapsed at
the time of election of a member, one-half of the annual dues shall be
remitted, making the admission fee in such cases $4.00. The admission
fee shall be returned if the applicant is not accepted.

Sec. 2. The annual dues shall be $2.00, and shall be payable on
January 1 of each year. Anj' member who shall fail to pay his annual
dues by April 1 shall be held as suspended without action on the part
of the Society. A member suspended for nonpayment of dues shall be
restored to fviU membership on payment of all indebtedness. Members
more than one year in arrears shall be dropped from the roll of
members.

Sec. 3. The fiscal year of this Society shall be from January to
December, inclusive.

Chapter VI. — Order, of Business.
The order of business shall be as follows:

1. Call to order by the President.

2. Pleading of minutes of last meeting.

3. Clinical cases.

4. Papers and discussions.

5. Unfinished business.

6. Miscellaneous business.

7. Announcements.

8. Adjournment.

N. C. MEDICAL, SOCIETY. 831

Chapter VII. — Rules of Order.

The deliberations of this Society shall be governed by parliamentary
usage as contained in Robert's Rules of Order, unless otherwise de-
termined by vote.

Chapter VIII. — Principles of Ethics.

The Principles of Ethics of the American Medical Association and of
the Medical Society of the State of North Carolina shall be the Code of
this Society.

Chapter IX. — Amendments.

These by-laws may be amended at any regular meeting by a two-
thirds vote therefor, provided that such amendment has been read in
open session at the preceding regular meeting, and a copy of the same
has been sent to each member by the Secretary ten days in advance of the
meetinsc at which final action is to be taken.

Alphabetical List of Members of the Medical Society of
the State of North Carolina, with County in Which
Local Membership and Residence is Indicated.

Name. County.

Anderson, C. A Alamance

Ashe, E. S Anson

Ambler, Chase P Buncombe

Archer, I. J Buncombe

Anderson, J. G Buncombe

Ashworth, W. G Buncombe

Anderson, Paul V Burke

Archey, L. M Cabarrus

Abernethy, H. L Catawba

Abernethy, W. L Catawba

Abernethy, J. F Cherokee

Aydlette, J. P Cleveland

Averitt, K. G Cumberland

Anderson, Abel Davidson

Adams, C. A Durham

Adams, C. E Gaston

Anders, McT. G Gaston

Armfield, D. A Guilford

Arnold, L. J Harnett

Abel, J. F Haywood

Allen, R. L Haywood

Allen, T. A Henderson-Polk

Adams, M. R. .. .Iredell- Alexander
Anderson, Thos. E.,

Iredell- Alexander

Abernethy, H. N; Lincoln

Ashworth, B. L McDowell

Alexander, J. R Mecklenburg-
Alexander, Annie h. .Mecklenburg

Alexander, H. Q Mecklenburg

Austin, J. A Mecklenburg

Austin, Fred Mecklenburg

Alien, Wm Mecklenburg

Achorn, J. Warren Moore

Asbury, F. E Montgomery

Akerman, Joseph. . . .New Hanover

Abernethy, E. A Orange

Attmore, Geo. S Pamiico

Aydlette, H. T.,

Pasquotank-Camden-Dare

Alexander, L. L Pender

Atkins, G. J Rowan

Andrews, R. M Rutherford

Allen, Joseph A Stanly

Anderson, J. N Stanly

Allred, E. W Surry

Ashby. Thos. B Surry

Armfield, R Union

Name. Vouuly.

Ashcraft, J. E Union

Alston, B. P Vance

Abernethy, C. O Wake

Anderi-on, Albert Wake

Alston, Willis Warren

Alston, Willis Jr Warren

Anderson, W. H Wilson

Anderson, W. S Wilson

Bairett, W. W Anson

Beckwith, R. B Anson

Bennett, J. II Anson

Ballon, J. L Ashe

Barton, J. H Ashe

Blcvins, Manly Ashe

Blount, W. A Beaufort

Blount, J. G Beaufort

Bonner, H. M Beaufort

Brown, Ed. M Beaufort

Bullock, W. J Beaufort

Battle, S. W Buncombe

Boyd, L Buncombe

Briggs, H. H Buncombe

Brookshire, H. G Buncombe

Brown, Thos. E. W Buncombe

Brownson, W. C Buncombe

Burroughs, Jas. A Buncombe

Beall, L. G Burke

Barrier, P. A Cabarrus

Black, J. C Cabarrus

Burloyson, L. N Cabarrus

Blackburn, T. C Catawba

Bonner. K. P. B Carteret

Badgett, J. F Caswell

Burns, Wm Chatham

Blake. J. F Cohimbus

Bullock, T. C Cumberland

Brown, G. W Cumberland

Baum, Julian Currituck

Buchanan, E. J Davidson

Bycrly, A. B Davie

Bodd'e, N. P Durham

Bowling, E. H Durham

Brooks, B. N Durham

Bnker, J. M Edtrecombe

Brothers, E. J Edgecombe

Buss, S. P Edgecombe

Bahnson, H. T Forsyth

N. C. MEDICAL SOCIETY.

833

Name. County.

Bynum, John Forsyth

Bynuin, Wahe H Forsyth

Burt, S. P Franklin

Bobbett, E. H Franklin

Boyette, E. C Gaston

Bunting, R. C Gaston

Brooks, G. C .Gates

Brock, G. F Graham

Booth, S. D Granville

Bannor, C. W Guilford

Battle, J. T. J Guiltord

Beall, W. P Guilford

Bowman, H. P Guilford

Boyies, J. H Guilford

Brooks, J. E Guilford

Brooks, Z. T Guilford

Burrus, John T Guilford

Burbage, T. J Hertford

Boyies, A. C Harnett

Brown, J. S Henderson-Polk

Bell, A. E Iredell- Alexander

Burgin, H. F Jackson

Booker, B. N Johnston

Baird, J. H Madison

Burnett, I. E Madison

Butt, V. E. Mitchell

Bryant, P. G Mitchell

Blair, A. M Moore

Bowman, H. E Montgomery

Battle, Jas. P Nash

Brantley, C. H Nash

Brantley, Hassell Nash

Bell, Chas. D New Hanover

Bellamy, W. J. H...New Hanover

Bellamy, R. H New Hanover

Bullock, D. W New Hanover

Bowman, J. H New Hanover

Bradford, R. H Penaer

Baynes, R. S Person

Bradsher, W. A Person

Brown, Zeno Pitt

Basnight, T. G Pitt

Brown, J. P Robeson

Bowers, A. H Rowan

Brawley, R. V Rowan

Brown, Geo. A Rowan

Busby, J. G Rowan

Bostic, W. C Rutherford

Biggs, H. M Rutherford

Blue, K. A Scotland

Bennett, A. M Swain

Blair, J. M Union

Blair, M. P Union

Bass, H. H Vance

Battle, K. P. Jr Wake

Name. County.

Bell, G. M Wake

Blalock, N. M Wake

Boone, W. H Wake

Buffalo, J. S WaJce

Burt, B. W Wake

Barefoot, J. J Wake

Barnes, B. F Wilson

Best, Henry Wilson

Blackwell, T. L Yadkin

Carpenter, S. B Anson

Covington, J. M Anson

Covington, J. M. Jr Anson

Call, T. J Asne

Colvard, J. W Ashe

Capehart, A Bertie

Credle, E. S Beaufort

Clark, Geo. L Bladen

Curtis, W. G Brunswick

Calloway, A. W Buncombe

Carraway, J. F Buncombe

Cheeseborough, Thos. P. Buncombe

Clemenger, F. J Buncombe

Cotton, Clyde E Buncombe

Carroll, R. S Buncombe

Cocke, Jere Buncombe

Caldwell, D. G Cabarrus

Carter, G. H Caldwell

Corpening, Oscar J Caldwell

Clarke, F. M Carteret

Campbell, Jas. R Catawba

Chapin, H. T Chatham

Casteel, L. R Cherokee

Champion, C. 0 Cleveland

Crowell, W. H Columbus

Caton. Geo. A Craven

Cathell, J. E Davidson

Clodfeltei", Chas. M Davidson

Carroll, J. W Duplin

Carr, R. L Duplin

Cheatham, Arch Durham

Copple, T. M Forsyth

Carlton, R. L Forsyth

Corbell, E. F Gates

Coffseshall, G. A Granville

Coble, W. A Guilford

Collins, Jno. A Halifax

Campbell, Archibald,

Iredell-Alexander
Cloninger, L. V. .Iredell- Alexander
Campbell, R. A. .Iredell-Alexander
Carpenter, F. A. .Iredell- Alexander

Candler, Chas. Z Jackson

Candler, J. M Jackson

Coleman, T. S Johnstoa

834

FIFTY-FIFTH ANNUAL SESSION

Name. Count ij.

Crowell, L, A Lincoln

Costlier, G. H Lincoln

Cheek, B. A McDov.-ell

Chaney, T. M McDowell

Crowe.l, A, J Mecklenburg

Costner, T. F Mecklenburg

Currie, E. W Mecklenburg

Clifford, J. S Mecklenburg

Caveness, A. H Moore

Covington, L. C Nash

Cranmer, J. B New Hanover

Caldwell, W. M New Hano\er

Cook, I. H Northampton

Cox, E. L Onslow

Crowell, W. H Pender

Cox, B. T Pitt

Crooiii, A. B Robeson

Cioom, J. D Robeson

Currie, D. S Robeson

Caldwell, J. A Rowan

Chenault, W. F Rowan

Cowan, Robt. L Rowan

Crump, W. L Rowan

Chapman, G. M Rutherford

Carpenter, F. A

Cooper, G. M Sampson

Crumpler, Paul Sampson

Campbell, J. I Stanly

Cox, B. F Stanly

Cooper, J. A Swain

CheTtham, Goode ...Transylvania

Carstarphen, W. T Vance

Caveness, Z. M Wake

Cooke, F. K Wake

Cotton, A. T Wake

Cohen, B. W Washington

Cobb, W. H. H Wayne

Cobb, W. H. H., Jr Wayne

Crocker, S. H Wilson

Clingman, J. J Yadkin

Dunlap, J. M Anson

Dixon, W. H Beaufort

Desher, J. Arthur Brunswick

David, J. E Buncombe

Dunn, Wm. L Buncombe

Davis, Geo Cnrtpret

Dunr-an. C. L Cnrter^t

Diiffv, Chaa Crnven

Duffv, Frnnk Craven

Duffy. Lein^ter Craven

Dve. .Tno. C Cumberland

Dnlton, D. N Forsvth

Dfilton, W. N Fo'-svth

Davis, A. P Forsyth

Davis, J. W Forsyth

Name. County.

Davis, W. W Gaston

Dodsoii, H. H Guilford

Davis, W. C Guillord

Denning, 0. L Harnett

Davis, F. M Haywood

Drafts, A. B Henderson-Polk

Dixon, Guy E. .. .Henderson-Polk

Davidson, J. E Mecklenburg

DcArmond, J. Mc Mecklenburg

Dalignv, Chas Montgomery

Dew, S. P Nash

Daniels, 0. C Pamlico

Dee s D. A Pamlico

Davis, J. J.,

Pasquotank-Camden-Dare

Dawson, W. W Pitt

Dixon, Joseph Pitt

Dickson, A. P Robeson

Doi>ett, E. Rose Rowan

Davis, Robt. L Swain

Dees, W. A Union

Dixon-Carroll, E. Delia Wake

Dickenson, E. T Wilson

Disosway, A. W Washington

Duncan, J. E Wilkes

Duffy, R. N Craven

Dees, R. O Guilford

Dick, J. V Guilford

Duncan, G. F Guilford

Denny, W. W Lenoir

Evans, L. B Bladen

Ella's, Lewis W Buncombe

Eckel, 0. F Buncombe

Everhart, W. H Catawba

Edwards, J. D Chatham

Ellis, Robt. C Cleveland

Eddleman, H. M Gaston

Edwards, G. C Greene

Edaerton, J. L.. . .Henderson-Polk

Encflish, I. L Mndi^on

Ewinnr, J. B Mitchell

Ellis, A. J Northampton

Everett, A. C Richmond

Evans, Wm. E Robeson

Everington, Geo. D Scotlmd

Enffl'sh, Ed. S Transylvania

Ewbnnks, .7. B Union

Fxnm, W. P. Jr ^Vivne

El'er, J. A Wilkes

FlVr, A. J Wilkes

Edwards, C. P Yancey

Fnure^t, T. S A^'^mnnce

Freerpan, R. A Alnmnnce

Fletcher, M. H Buncombe

N. C. MEDICAL SOCIETY.

J^iD

Name. County.

Flew, J. W Cabanus

Foil, M. A Cabaniis

Flowers, G. E L'ald v\ ell

Flow eis, C. E Caldwell

1 loyd, A. G Columbus

Feiieil, J. A Duplin

Faison, J no. M Duplin

Felts, K. L Durham

Feanngton, J. P Foisyth

Flynt, S. S Forsyth

Fulp, E., Forsyth

Fioyd, R. P Franklin

Fortune, A. F Guiltord

Fox, M. F Guilford

Farrar, M. R Guilford

Foscue, J. E Guilford

Ferguson, H. B Halifax

Few, Columbus . .Henderson-Polk

Freeman, W. G Hertford

Frisbee, J. T Madison

Fleming, M. I Martin

Faison, I. W Mecklenburg

Ferguson, K. M Moore

Flowers, C. A Pamlico

Fearing, I.,

Pasquotank-Camden-Dare
Fearing, Zenos,

Pasquotank-Camden-Dare
Ferrebee, C. G.,

Pa?quotank-Camden-Dai'e
Fearing, W. I?.,

Pasquotank-Camden-Dare

Frizzelle, M. T Pitt

Fox, Thos. I Randolph

Fau t, D. L .Randolph

Fowlke-, J. I Richmond

Fitzgerald, J. F Rowan

Flip]jen, J. Meigs Rowan

Foust. I. H Rowan

Fulp, Ellas Stokes

Flippen, R. E. L Surry

Flippen, S. T Surry

Fenner, E. F Vnnce

Ferrebee. E. B Wake

Fowler, M. L Wnke

Farthing, L. E Watauga

Faison, W. W Wnvne

Fassett, B. W Yadkin

Golev, W. R Alnmnnr'e

Goodnipn, E. G Brunswick

G'enn. E. B BniT-oinl-e

Gmi<?er, G. .J Cnhirnis

Grier, S. A Cabarrus

Name. County,

George, D. S Carteret

Graham, VVm. A Cheiokee

Gregg, VV. T Cleveland

Gibbs, N. M Craven

Graham, Geo. A Cumberland

Garrington, J. F Currituck

Griggs, W. T Currituck

Gibbs, J. B Davidson

Graham, B. R Duplin

Graham, Joseph Durham

Graham, Wm. A Durham

Gray, E. P Forsyth

Grillith, J. F Forsyth

Garien, R. H Gaston

Garrison, D. A Gaston

Glenn, H. F Gaston

Glenn, L. N Gaston

Gilmer, C. S Guilford

Gordon, J. R Guilford

Gove, Anna M Guilford

Gray, Claiborn Guilford

Grimsley, J. E Guilford

Glasscock, Joy Harris . . . .Guilford

Grayson, C. S Guilford

Green, 1. E Halifax

Graham, VV. A Haywood

Greenwood, B. H Haj^vood

Grady, Earl Henderson-Polk

Greenwood, S. E. .Henderson-Polk
Guerard, Arthur R.,

Henderson-Polk

Green, A. W Hertford

Gray, R. H Hertford

Grady, J. C John-^ton

Griffin, J. A Johnston

Garren, R. H McDowell

Gilbert, W. W McDowell

Graham, W. A Mecklenburg

Grantham, N. L ^Montgomery

Gilmor, N. D Montoomery

Gilbert, W. W INIcDoweil

Green, T. M New Hanover

Gibbon, J^hn H Mecklenburg

Gibbon, Robt. L IMecklenburg

(Vadmon. Edwin Moore

Gi'more, W. D Moore

Griggs, J. B.,

Pasquotank-Camden-D've

Grimes, R. J Pitt

Gnrrett, F. J Richmond

Gaither, J. B Rowan

(Toodman, A. B Rowan

Oib-nn, J. S Scotland

G'hcon, M. R Rohe=on

Gill, R. J Vance

836

FIFTY-FIFTH ANNUAL SESSION

Name. County.

Gaines, L. M Wake

Goodwin, A. W Wake

Ginn, T. L Wayne

Gilreath, F. H Wilkes

Hart, J. E Anson

Hardy, Ira M Beaufort

Hunter, H. H Beaufort

Harrell, W, J Bertie

Horton, E. H Bertie

Harris, I. A Buncombe

Holmes, L. E Buncombe

Hemell, M. H Buncombe

Hall, Jas. K .Burke

Hennessee, E. A Burke

Headen, W. E Carteret

Highway, S. C Cherokee

Hammond, A. F Craven

Hughes, F. W Craven

Highsmith, Seavy ....Cumberland

Highsmith, J. F Cumberland

Hill, D. J Davidson

Hill, Joel Davidson

Hill, W. Lee Davidson

Hus?ev, L Duplin

Hatcher, T. E Duplin

Hicks, C. S Durham

Hicks, W. N Durham

Holloway, R. L Durham

Harrell, S. N Edgecombe

Haines, J. L Forsyth

Hammock, J. C Forsyth

Harris, J. H Franklin

Henderson, R. B Franklin

Hay, W. S Gaston

Hunter, B. R Gaston

Hunter, M. C Gaston

Howell, S. F Graham

Hooper, L. D Graham

Hays, Ben. K Granville

Hardee, P. R Granville

Harper, James H Greene

Harrison, Edmund Guilford

Hilton, J. J Guilford

Holt, W. T Guilford

Harrison, A. S Halifax

Halford, J. W Harnett

Hicks, I. F Harnett

Hifjhsmith, Chas Harnett

Holt, W. P Harnett

Hud'^on, W. L Harnett

Hyatt, Fred. C Haywood

HoAve, W. B. W., .Henderson-Polk

Hood, J. S Henderson-Polk

Harris, J. E Hyde

Hall, E. A Iredell- Alexander

Name. County.

Houck, Albert . . Iredell-Alexander

Hill, W. J Iredell-Alexander

Hooper, Delos D Jackson

Hooks, Thel Johnston

Hocutt, B. A Johnston

Hargrove, W. F Lenoir

Hodges, J. M Lenoir

Hoover, Chas. H Lincoln

Hargrove, W. H Martin

Hawley, F. 0 Mecklenburg

Henderson, S. M Mecklenburg

Hunter, L. W Mecklenburg

Ho vis, Leighton . . . .Mecklenburg

Hoyle, Hughes B Moore

Harris, A. H New Hanover

Harper, Chas. T New Hanover

Honnett, J. H New Hanover

Hall, Wright New Hanover

Hester, J. R Orange

Hughes, C. M Orange

Hudson, J. H Pitt

Henly, Sam A Randolph

Hubbard, C. C Randolph

Hunter, J. V Randolph

Hunter, N. C Richmond

Hodgiu, H. H Robeson

Heilig, H. G Rowan

Holshaiser Rowan

Harris, E. B Rutherford

Harrell, L. B Rutherford

Hamrick, T. G Rutherford

Hicks, O Rutherford

Hicks, Romeo Rutherford

Haynes, B. M Rutherford

Holmes, F. H Sampson

Hiatt, H. B Sampson

Hamer, A. W Scotland

Hartsell, F. E Stanly

Hathcock, T. A Stanly

Hill, W. I Stanly

Hall, J. Clegg Stanly

Hill, L. H Stokes

Hollingsworth, Ed. M Surry

Hollingsworth, J. M Surry

Hollingsworth, R. E Surry

Holt, Russell D Swain

Hunt, C. W Transylvania

Houston, H. C Union

Harris, F. R Vance

Harris, H. H Wake

Hayden, Catherine P Wake

Haywood, F. J Wake

Havwood, Hubert Wake

Holding, S. P Wake

Horton, W. C Wake

Holt, T. J Warren

N. C. MEDICAL SOCIETY.

837

Name. County.

Hassell, J. L Washington

Halsey, B. F Washington

Hardison, W. H Washington

Hodges, J. M Watauga

Hoiton, W. P Wilkes

Herring, B. S Wilson

Harrison, J. S Wilson

Holconib, CM Yadkin

Hutchins, E. M Yadkin

Harding, T. R Yadkin

Ivey, W. P Caldwell

Irwin, Jno. R Mecklenburg

Ingram, C. B Montgomery

Jones, A. L Ashe

Jones, T. J Ashe

Jones, R. W Ashe

Jenkins, P. C Bertie

Jackson, Beaufort

Jordan, Chas. S Buncombe

Johnson, A. E Buncombe

Jones, A. D Caldwell

Johnson, J. T Catawba

Johnson, Thos. C Columbus

Jordan, D. B Columbus

Jones, R. DuVal Craven

Jordan, Wm. S Cumberland

Julian, Chas. A Davidson

Johnson, N. M Durham

Jordan, A. C Durham

Jewett, R. D Forsyth

Jenkins, J. T Forsyth

Jenkins, J. H Gaston

Jones, J. W Guilford

Jordan, G. E Guilford

Jones, W. M. Jr Guilford

Jones, E. H Hyde

Jurney, P. C Iredell-Alexander

Jones, Harry M Macon-Clay

Justice, M. L McDowell

Justice, G. B McDowell

Joyner, R. W Northampton

Joyner, T. D Northampton

James, F. C Pitt

Jones, C. M Pitt

Joyner, C. C Pitt

John, Peter Scotland

Jones, Wm. D Scotland

Jones, A. G Stokes

Jerome, J. R Union

Jenkins, C. L Wake

Johnson, R. W Wake

Jordan, T. M Wake

Judd, J. M Wake

Kerr, J. Edwin Anson

Name. County.

Kellum, Wm. D Beaufort

King, R. M Cabarrus

Kent, A. A Caldwell

Kirkman, T. A Chatham

Kimbraugh, M. D Davie

Kapp, H. H Forsyth

Kernodle, G, W Guilford

Knight, W. P Guilford

Kirkpatrick, Wm. L Haywood

Kirk, Wm. R Henderson-Polk

King, J. E Iredell- Alexander

Klutz, E. E Iredell-Alexander

Knight, J. B Martin

Kirby, Guy S McDowell

King, Parks M Mecklenburg

Knox, John Mecklenburg

Keerans, L. C Mecklenburg

Kinsman, H. F Richmond

Kirkpatrick, L. R Robeson

Kitchen, T. D Robeson

Kent, John J Robeson

Kerr, C. S Sampson

King, O. D Stanly

King, M. M Transylvania

Knox, A. W Wake

Kennedy, J. B Wayne

Kornegay, L. W Wayne

Long, Geo. W Alamance

Lemly, S. T Ashe

Lucas, W. H. G Bladen

Laird, E. C Buncombe

Lee, P. H Buncombe

Lafferty, J. S Cabarrus

Love, B. E Caswell

Long, Fred. Y Catawba

Lattimore, E, B Cleveland

Lee, L. V Cleveland

Lilly, J. M Cumberland

Lane, Jno. L Duplin

Landing, J. F Duplin

Linville, A. Y Forsyth

Lockett, E. A Forsyth

Lott, H. S Forsvth

Lee. W. C. P Gates

Ledbetter, A. E Guilford

Little, Thos. R Guilford

Long, Jno. W Guilford

Logan, Jno. E Guilford

Leggett, K Halifax

Leei S. P. J Harnett

Long, H. F Iredell-Alexander

Loophson. Mary E Macon-Clay

Lyle, S. H Macon-Clay

Long, B. L Martin

838

FIFTY-FIFTH ANNUAL SESSION

Name. County.

Lafl'erty, E. S Mecklenburg

Long, V. M Meckienbuig

Laster, P. D Moore

Love, L. H New Hanover

Lewis, H. W Northampton

Lumsden, W. J.,

Pasquotank-Camden-Dare
Lister, J. L.,

Pasquotank-Camden-Dare

Long, W. T Person

Love, B. E Person

Laughinghouse, Chas. 0'H....Pitt

Ledbetter, J. M Richmond

Lovelace, T. B Rutherford

Lee, A. M Sampson

Leak, J. J Stokes

Lawrence, C. L Surry

Lyda, A. E Transylvania

Lyda, W. M Transylvania

Lewis, R. H Wake

Lee, JR. E Wayne

Lamm, I. W Wilson

Leak, W. G Yadkin

Montgomery, H. M Alamance

Moore, H. R Alamance

Mei enheimer, T. F Anson

Mariner, N. B Beaufort

Mitchell, Wayland Bertie

Moore, Tilon V Brunswick

Merriwether, F. T Buncombe

Merrimon, Louise A. ...Buncombe

Minor, C. L Buncombe

Morris, E. R Buncombe

ManviLe, W. E Buncombe

Morse, L. B Buncombe

Mathews, J. M Cabarrus

Mattocks, C. J Caldwell

Moore, J. C Caldwell

Malloy, S. A Caswell

Menzies, H. C Catawba

Mitchell, W. F Cleveland

Morrison, Rufus R Cleveland

Maxwell, F. B Columbus

Marsh, J. H Cumberland

Mann, S. M Currituck

Mack, J. H Davidson

Myers, J. A Davidson

Mock, F. L Davidson

Martin, J. F Davie

Martin, W. C Davie

Mann, T. A Durham

Manning, J. M Durham

Moore, R. A Durham

Name. County.

Mercer, W. P Edgecombe

Malone, J. E Franklin

Mann, J.J Franklin

Matheson, J, F Gaston

Maxwell, M. F Graham

Meadows, E. B Granville

Morris, J. A Granville

Murphy, W. B Greene

Meadows, W. J Guilford

Michaux, E. R Guilford

Miles May S Guilford

Moseley, C. W Guilford

Morrison, J. W Guilford

Melvin, W. C Harnett

Moore, F. T Harnett

Mease, J. H Haywood

Mitchell, J. H Hertford

Mitchell, Paul Hertford

Mann, J. A Hyde

Mann, J. E Hyde

Moore, J. T Iredell-Alexander

Moore, N. G Iredell- Alexander

Munns, L. A Johnston

Monk, H. S Lenoir

Monk, H. G Lenoir

IMorphew, M. F McDowell

Martin, Mary L Mecklenburg

Mason, R. E Mecklenburg

Meisenheimer, C. A. . .Mecklenburg
Montgomery, J. C. ...Mecklenburg

Moore, B. S Mecklenburg

]\Iunroe, J. P Mecklenburg

Monroe, J. P Moore

Monroe, W. A Moore

Matthews, J. H Moore-Lee

]\Iatthews, M. L Moore-i^ee

Mudgett, W. C Moore-Lee

Miller, R. B Nash

Mariott, M. B Nash

Matthews, T. A Nash

Murphy, J. G New Hanover

Moorehead, R. P Northampton

Muhlon, Bolton ....Northampton

Manning, I. H Orange

INIangum, C. S Orange

Murphy, W. E Orange

Merritt, J. H Person

Morrill, D. S Pitt

Morrill, Jenness Pitt

Voye, E. A. Jr Pitt

Moore, W. J Randolph

]\Iills, J. C Rockingham

Monk, H. L Rowan

Matthews, J. 0 .Sampson

N. C. MEDICAL SOCIETY.

839

Name. County.

Moir, S. A Stokes

Mooie, W. B Stokes

Me bane, W. C Surry

Mashburn, B. D Wake

Moncure, Wm Wake

Mashburn, H. H Wake

Macon, P. J Warren

Myers, J. Q Wilkes

Moore, C. E Wilson

Moore, E. G Wilson

McPherson, J. W^ Alamance

McPherton, S. D Alamance

McBrayer, L. B Buncombe

McCracken, CM Buncombe

McLean, J. N Buncombe

McCampbell, Jno. M Burke

Mc^airy, C. B Caldwell

McBride, M. H Caswell

McBrayer, T. E Cleveland

McKay, J. L Cleveland

McGougan, J. V Cumberland

McKethan, Jno. A. ...Cumberland

McLean, Chas. E Gaston

McAnally, W. J Guilford

McKay, .J. F Harnett

McLean, J. W Harnett

McCracken, J. R Haywood

]\IcLaughlin, J. E.,

Iredell- Alexander

McLemore, G. A Johnston

]\IcDavitt, A. J Madison

McLaughlin, C. S. ...Mecklenburg

[McDonald, A. A Moore

]\lclver, Lynn Moore

jMcLeod, A. H Moore

]VIcLeod, Gilbert Moore

Mcintosh, D. M McDowell

McDonald, A. D New Hanover

McMillan, W. D New Hanover

MacNider, Wm. DeB Orange

McMullan, Oscar,

Pasquotank-Camden-Dare

McMullen, T. S i:'erquimans

McFayden, Paul R Randolph

McPhail, L. D Richmond

McKinnon, W. H Robeson

McMi'lan, Ben. F Robeson

McMillan, J. L Robeson

McNatt, H. W Robeson

McPhail, W. A Robeson

McMurray, H. E Robeson

McKenzie, .J. C Robeson

McGehee, J. W Rockingham

McKenzie, W. W Rowan

McLean Sampson

Name. County.

McLean, Neil M Scotland

McCiain, W. R Union

McAli^ter, Wm Vance

MtCullers, J. J. L Wake

McGeachy, R. S Wake

McGee, J. W Wake

McKee, Jas Wake

McGee, J. W. Jr Wake

Nicholson, S. L Beaufort

Nicholson, J. T Beaufort

Nichol'oi;, P. A Beaufort

Nicholson, S. T Beaufort

Nowell, L. A Bertie

Norniiin, Geo. W Caswell

Nesbitt, Chas. T Craven

Newbern, J. M Currituck

Newr.l!, H. A Franklin

Nicholson, W. G. Iredell-Alexander
Nicholson, W. G. Iredell-Alexander

Nichols, A. A Jackson

Noble. I!. J Johnston

Nick, G. D Johnston

Nelson, R. J Martin

Nisbet, W. 0 Mecklenburg

Xicholr-on, J. L Onslow

Nichols, C. G Person

Nobles J. E Pitt

Kovmciit. R. M Robeson

torment, 'J'. A Robeson

Northrup, T. L Robeson

Norris, Henry Rutherford

McLean, Peter Scotland

Neal, J. W Stokes

Nance, Geo. B Union

Neal, Jno. W Union

OfT, C. (^ Buncombe

Orr, Peter B Buncombe

Orr, R. J Cherokee

Gates, Geo. Cleveland

Olive, 1'. W Cumberland

0"Kel!y, J. M Durham

Olive, "W. W Durham

Page, Jno. W Alamance

Pickett, J. A Alamance

Parris, 0. J Alamance

Pennington, S. E Ashe

Pritchard, Jno. L Bertie

Paquin, Paul Buncombe

Purefoy, Geo. W Buncombe

Pritchard, A. T Buncombe

Phifer, Ed. W Burke

Pemberton, W. D Cabarrus

840

FIFTY-FIFTH ANNUAL SESSION

'Name. County.

Phair, T. F Cabarrus

Paul, W. T Carteret

Price, K. A Catawba

Palmer, R. W Chatham

Patton, W. 0 Cherokee

Palmer, B. H Cleveland

Pollock, Raymond Craven

Primrose, R. S Craven

Patterson, J, F Craven

Peacock, J. W Davidson

Phillips, J. J Edsjecombe

Pfohl, S. F .Forsyth

Pepper, J. K Forsyth

Patrick, G. R Gaston

Paddison, J. R Guilford

Pierce, S. B Halifax

Pollard, W. B Hertford

Parker, G. E Johnston

Person, J. B Johnston

Parrott, James M Lenoir

Parrott, W. T Lenoir

Parrott, A. DeK i^enoir

Pridgeon, C. L Lenoir

Petrie, R. W Lincoln

Peek, E. J Madison

Peeler, C. N Mecklenburg

Pharr, W. W Mecklenburg

Pressly, Geo. W Mecklenburg

Peeler, C. N Mecklenburg

Peterson, C. A Mitchell

Palmer, R. W Moore

Phillips, J. B, Jr Nash

Parris, D. C Orange

Patrick, J. E Pitt

Pate, G. M Robeson

Pope, H. T ■ Robeson

Poole, CM Rowan

Peeler, J. H Rowan

Pate, W. T Scotland

Prince, D. M Scotland

Philips, M. D Stokes

Price, W. H Union

Perkins, D. R Union

Pendleton, A. S Vance

Penny, J. A. J Wake

Powers, J. B Wake

Perkins, F. E Warren

Powell, W. E ; Wayne

Parker, J. R Wayne

Pegrani, R. W. S Wilkes

Quickel, T. C. . .

Rodman, Jno. C.
Ruflin, J. B. . . .

, . .Gaston

.Beaufort
. . .Bertie

Name. County.

Robinson, Newton Bladen

Reagan, J. A Buncombe

Reagan, W. L Buncombe

Reed, C. E Buncombe

Reynolds, Carl V Buncombe

Reynolds, T. F Buncombe

Reynolds, J. H .Buncombe

von Ruck, Karl Buncombe

von Ruck, Silvio Buncombe

Ringer, P. H Buncombe

Riddle, Jos. B Burke

Rogers, Francis 0 Cabarrus

Royster, S. S Cleveland

Rhein, J. F Craven

Rose, A. S Cumberland

Ritter, F. W Currituck

Rodwell, J, W Davie

Ross, Geo. H Durham

Reid, R. M Gaston

Robinson, Frank Gaston

Reitzel, C. E Guilford

Reitzel, J. R Guilford

Richardson, W. J Guilford

Roberson, Chas Guilford

Reives, J. T Guilford

Reurs, W. P Guilford

Rowlands, H. W Harnett

Russell, Lloyd P., Henderson-Polk

Robinson, G. J Johnston

Rose, A. H Johnston

Rogers, W. A Macon- Clay

Roberts, Frank Madison

Robinson, W. F Madison

Rhodes, J. S Martin

Russell, E. Reid Mecklenburg

Reed, W. K Mecklenburg

Russell, F. H New Hanover

Reed, D. H Northampton

Riddick. W. M Perquimans

Ricks, L. E Pitt

Reedy, Howard Robeson

Rosier, R. G Robeson

Rosier, S. B Robeson

Ray, J. B Rockingham

Rnmsour, G. A Rowan

Reid, Geo. P Rutherford

Ring, J. W Surry

Reece, J. M Surry

Ray. O. L Wake

Rankin, W. S Wake

Rogers, Jng. R Wake

Royster, H. A Wake

Royster, W. I Wake

N. C. MEDICAL SOCIETY.

841

Name. County.

Roberts, J. D Wayne

Robiuson, M. E Wayne

Royail, iVi. A Yadkin

Rusfecll, S. L Yadkin

i^ay, J . L Yancey

Robertson, W. B Yancey

Stafford, W. G Alamance

Smith, L. C Anson

Staley, S, W Beautort

Sawyer, James Buncombe

Sevier, Jos. T Buncombe

Smitli, Owen Buncombe

Stevens, M. L Buncombe

Snioot, J. E Cabarrus

Shutord, J. H Catawba

Stevenson, T. F Catawba

Smith, W. F Columbus

Stovy, J. G Caldwell

Street, N. H Craven

Shaw, Henry M Currituck

Smith, J. A Durham

Staton, L. L Edgecombe

bpeight, J. P Edgecombe

Shatiner, J. F Forsyth

Shaffner, J. F. Jr Forsyth

Spainhour, E. H Forsyth

Spencer, W. O Forsyth

Strickland, E. F Forsyth

Summers, C. L Forsyth

Sloan, J. M Gaston

Sanderford, J. F Granville

Sikes, G. T Granville

Stamy, E. L Greene

Scott, C. L Guilford

Stanton, D. A Guilford

Sexton, C. H Harnett

Smith, F Harnett

Stringfie'd, Thos Haywood

Stringfield, Sam L. Ha v wood

Sulley, E. M Henderson-Polk

Sharpe, F. L Iredell- Alexander

Stevenson, S. W. Iredell- Alexander

Self. Wm Jackson

Stanly, Jno. H Johnston

Smithwick, J. W. F Lenoir

Saine, Jno. W Lincoln

Siler, F. L Macon-Clay

Saunders, J. H Martin

Smithwick, J. E Martin

Simmons, Jno. 0 Mecklenburg

Slagel, F. P Mitchell

Sheppard, J. L Moore

Shields, H. B. Moore Moore

Snipes, E. P Moore

Name. County.

Street, M. Eugene Moore

Swett, W. P Moore

Shamberger, J. B Montgomery

Speight, R. H. Jr Nash

Strickland, J. T Isiash

Schonwald, Jno. T. . .New Hanover

Slocum, R. B New Hanover

Stancill, R. H Northampton

Sutton, C. W Onslow

Sawyer, C. W.,

Pasquotank-Camden-Dare
Sawyer, W. W.,

Pasquotank-Camden-Dare

Smith, R. W Perquimans

Swann, J. F Person

Schaub, 0. P Person

Skinner, L. C Pitt

Summers, W. I Randolph

Steele, W. H Richmond

Stamps, Thos Robeson

Stephens, Wm. F Robeson

Sweany, Jno Rockingham

Sawyer, C. J Rowan

Smoot, M. L Rowan

Summerell, E. M Rowan

Stokes, J. E Rowan

Sikes, G. L Sampson

Sloan, Henry Sampson

Stevens, J. A Sampson

Shaw, Daniel Scotland

Shaw, Wm. G Scotland

Smith, J. T Stokes

Smith, J. B Surry

Stone, Wm. M Surry

Stevens, S. A Union

Stewart, H. D Union

Sorrell, L. P Wake

Stevens, Ralph S Wake

Speight, J. W Washington

Spicer, William Wayne

Sutton, W. G Wayne

Sexton, J. A Wake

Somers, L. P Wilkes

Shore, Thad. W Yadkin

Salmons, H. C Y^idkin

Tate, W. N Alamance

Tyson, T. D Alamance

Thompson, CD Anson

Testermnn, J. C Ashe

Tayloe, David T Beaufort

Tayloe, Joshua Beaufort

Tayloe, Armistead K. ...Beaufort

Tennent, G. S Buncombe

Taylor, I. M Burke

84:2

FIFTY-FIFTH ANNUAL SESSION

Name. County.

Taylor, J. N Chatham

Thornton, Irene Cumberhmd

Teague, R. J Durham

Thigpen, W. J Edgecombe

Turner. J. A Guilford

Turner, J, P liuiltord

Thames, John Guilford

Tankersley, J. W G^iilford

Tull, Henry Lenoir

Thompson, C. D Lincoln

Tilson, J. C Madison

Thomas, P. G New Hanover

Thomas, Geo. T. ...New Hanover

Thompson, Cyrus Onslow

Thigpen, G. T Pitt

Tuttle, A. F Rockingham

Thompson, N. A Robeson

Trantham, H. T Rowan

Twitty, J. C Rutherford

Twitty, T. B Rutherford

Thompson, J. B Rutherford

Thompson, W. A Rutherford

Taylor, W. 1 Sampson

Taylor, W. S Surry

Thompson, K Surry

Teague, J. H Swain

Tucker, Jno. H Vance

Templeton, Jas. M Wake

Thompson, S. W Wake

Tucker, H. McKee Wake

Turner, J. M Wilkes

Utley, H. H Harnett

Underbill, H. P Pamlico

Utley, B. S Wake

Vestal, W. J Davidson

Vick, Geo. D Johnston

Valentine, Thos Northampton

Walker, W. E Alamance

Walker, L. A Alamance

Watson, Geo. S Alamance

Wyatt, J. L Anson

Windley, U. T Beaufort

Watson, D. I Brunswick

Weaver, H. B Buncombe

Whittington, W. P Buncombe

Williams, J. H Buncombe

Warlick, E. S Burke

Wallace, J. W Cabarrus

White, W. M Caldwell

Wibon, C. L Caldwell

Whitesides, B. F Catawba

Wilson, W. E Catawba

Name. County.

Webb, Ben. G Cherokee

Wood, J. W Cleveland

Withers, S. M Columbus

Wiilingham, B. J Cumberland

Watkins, T. T Davie

Williams, J. M Duplin

Ward, M. P Jjurnam

Wilkerson, Chas. B Durham

Woodard, C. A Durham

Whitehead, J. P Edgecombe

Whitehead, W. H Edgecombe

Whittaker, W. H Edgeoijx.\'oe

Walton, C. B Edgecombe

Williams, J. D Forsvth

Wright, J. Thos Forsyth

Wheless, J. R Franklin

Wilkins, S. A Gaston

Wilson, F. G Gaston

Williams, Geo. D Gates

West, Albert Greene

Whittington, W. W Greene

Watkins, G. S uranville

Wilson, A. R Guilford

Williams, Jno. R Guilford

Williams, Jno. A Guilford

Whittaker, A. C Guilford

Wills, J. M Guilford

Williams, B. B Guilford

Way, J. Howell Haywood

Willis, A. P Haywood

Wilson, J. E Haywood

Waldiop, J. G. ...Henderson-Polk

Ward, J. E Hertiord

Windley, R. E Hyde

Williams, J. W Hyde

Wharton, L. D Johnston

Whittaker, R. A Lenoir

Woodley, C. B Lenoir

Wootten, R. W Lenoir

Whitaker, F. A Lenoir

Wright, J. V Lincoln

Weaver, W. J Madison

Woody, S. B Madison

Warren, W. E Martin

Wakefield, W. H Mecklenburg

Walker, C. E Mecklensurg

Whisnant, A. M Mecklenburg

Winchester, F. M Mecklenburg

Witherbee, W. D Mecklenburg

Wooten, W. H Mecklenburg

Wakefield, H. W Mecklenburg

Wilcox, J. W Moore

Watson, Leon Moore-Lee

Wessell, J. C New Hanover

Wood, E. J New Hanover

N. C. MEDICAL. SOCIETY.

843

Name. County.

Whitehead, R. H Orange

Williams, Claude B.,

Pasquotank-Camden-Dare
Wood, J. E.,

Pasquotank-Camden-Daie
Walker, H. D.,

Pasquotank-Camden-Dare

Williams, R. J Tenaer

White, Thos. N Perquimans

Whitfield, W. C Pitt

Wilborn, W. R Randolph

Webb, W. P Richmond

Williamson, J. H Richmond

Wharton, C. R Rockingham

West, R. M Rowan

Whitehead, Jno Rowan

Withers, Banks Rowan

Woodson, C. W Rowan

Wiseman, C. B Rutherford

Wilson, R. B Sampson

Whitley, D. P Stanly

Whitley, V. A Stanly

Woltz, J. L ourry

Woltz, J. R Surry

Name. Co unit/.

Wallis, W. J Transylvania

Whitley, A. D. N Union

Ward, W. H Washington

Whitaker, Joel Wake

Wi.kerson, C. B Wake

White, J. W Wilkes

Williams, A. F Wilson

York, N. D Alamance

Young, R. S Cabarrus

York, A. A Davidson

Yarborough, R. F Franklin

Young, E. il. ... Iredell- Alexander

Young, J. J Johnston

York, H. B Martin

Y'oung, J. W Rowan

Young, G. E Rutherford

Young, L. B Wake

Zimmerman, C. St. V... Buncombe

Zimmerman. R. U Davidson

Zollicoflfer, A. B Halifax

ZollicofTer, D. B Halifax

Members of the Component County Medical Societies
of the Medical Society of the State of North Caro-
lina, June 16, 1908.

(Gentlemen will confer a favor upon the Secretary by promptly ad-
vising of any errors, deaths, removals or other changes noted. It is
desired to preserve the record as accurate as possible, and it is to be
remembered that it vnll be ju^t so accurate as reported by the County
Society officers and members.)

ALAMANCE COUNTY SOCIETY.

Joined
Members and Address. Licensed. State

Society.

President, Wm. R. Goley, Graham 1885 1893

Coll. P. & S., Balto., 1885.

Secretary, L. A. Walker, Burlington 1899 1904

Univ. Coll. Med., Va., 1899.

Anderson, C. A., Burlington 1893 1899

P. & S., Balto., 1900.

Faucette, Thos. S., Burlington 1893 189G

Balto. Med. Coll., 1893.

Freeman, R. A., Burlington 1879 1904

1 1-2 course. Wash. Univ., Balto., 1879.

Montgomery, H. M., Burlington 1903 1904

N. C. Med. Coll., 1903.

Moore, H. R., Burlington 1899 1904

P. & S., Atlanta, 1899.

Page, J. W., Burlington 1904

P. & S., Balto.

Pickett, J. A., Burlington, R. F. D 1894 1904

Univ. Nashville, 1894.

Stafford, W. G., Burlington 1879 1890

Bellevue, N. Y., 1871.

Long, G. W., Graham 1877 1877

Univ. Pa., 1877.

McPherson, J. W., Haw River 1898 1898

Balto. Med. Coll., 1898.

McPherson, S. D., Haw River 1903 1903

Univ. Md., 1903.

Tate, W. N., Mebane 1905

Louisv. Med. Coll., 1874.

Tyson, T. D., Mebane 1899 1904

Univ. Coll. Med., Va., 1899.

Y'ork, N. D., Mebane 1905

Mann, E. D., Saxapahaw ....

Parish, 0. J., Graham 1897 1904

Balto. Med. Coll., 1897.

X. C. MKDICAL SOCIETY. 845

Joined
Members ami Address. Licensed. State

Society.

Watson. Geo. S., Elou College 1904

P. & S., Balto., 1874.

Walker, W. E., Graham 1903 1905

Med. Coll., Va., 1903.

ANSON COUNTY SOCIETY.

President, J. M. Dunlap, Ansonville 1904

Univ. N. Y., 1876.
Secretary, J. M. Covington, Jr., Wadesboro 1899 1904

Med. Chi., Philadel., 1899.
Ashe, E. S., Wadesboro 1885 1904

Coll. P. & S., Balto., 1885.

Barrett, \Y. W., Peachland 1897 1904

Ky. Sch. Med., 1892.

Beckwith, R. B., Morven 1904

Vanderbilt Univ., 1883.

Bennett, J. H., Wadesboro 1894 1904

Univ. Md., 1894.

Carpenter, S. B., Cedar Hill 1904

Univ. N. Y., 1876.

Covington, J. M., Wadesboro 1879 1879

Med. Coll. S. C, 1874.

Hart, J. E., Deep Creek 1904

Univ. Md., 1897.

Kerr, J. Edwin, Lilesville 1898 1898

Univ. Md., 1898.

Meisenheinier, T. F., Morven 1881 1881

Univ. N. Y., 1880.

Smith, L. C, Polkton 1904

Balto. Med. Coll., 1892.

Thompson, C. D., Morven 1901 1904

Univ. Tenn., 1901.
Wyatt, J. L., Lilesville ....

ASHE COUNTY SOCIETY.

President, J. W. Colvard, Jefferson 1904

Attended P. & S., Balto., 1 year, 1883.

Secretary, J. L. Ballou, Shiprock, N. M 1902 1902

Univ. Nashville. 1901.

Barton, J. H., Weaver's Ford 1904

Registered on oath practice prior to 1885.

Blevins, Manly, Beaver Creek 1904

Registered on oath practice prior to 1885.

Call, T. J., Gap Creekmore 1904

Grad. P. & S., Balto.
Registered on permit B'd. Exs. practice prior to 1885.

84G FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Jones, A. L., Brandon 1901 1904

Univ. Coll. Med., Va., 1901.

Jones, T. J., Lansing 1904

Tenn. Med. Coll., 1895.

Jones, R. W., Clifton 1904

Lemly, S. T., Todd 1904

Pennington, S. E., Sturgills 1892 1904

P. & S., Balto., 1891.
Testerman, J. C, Jefferson 1904

BEAUFORT COUNTY SOCIETY.

President, P. A. Nicholson, Washington 1889 1901

P. & S., Balto., 1889.

Secretary, Ira M. Hardy, Washington 1902 1902

Med. Coll., Va., 1901.

Blount, W. A., Washington 1892 1894

Bellevue Med. Coll., 1892.

Blount, J. G., Washington 1892 1893

Bellevue Med. Coll., 1892.

Brown, E. M., Washington 1896 1901

Bellevue Med. Coll., 1896.

Bullock, W. J., Belhaven 1904

Univ. Pa., 1858.

Dixon, W. H., Edwards 1901 1901

Med. Coll. Va., 1901.

Hunter, H. H., Pinetown 1901 1904

Med. Coll. Va., 1900.

Kellum, W. D., Belhnven 1904

Mariner, N. B., Belhaven 1903 1904

Univ. Coll. Med., Va.

Nicholson, J. L., Washington 1904 1900

Univ. Med., 1904.

Nicholson, J. T., Bath 1885 1904

P. & S., Balto., 1885.

Nicholson, S. T., Washington 1885 1902

P. & S., Balto., 1881.

Rodman, John C, Washin"'tnn 1892 1895

Bellevue Med. Coll., 1892.

Small, W. P., Washington 1905

Univ. N. Y., 1875.

Staley, S. W., Aurora 1901 1904

Med. Coll. S. C, 1901.

Tayloe, D. T., Washington 1885 1885

B-lIevue Med., 1885.

Tayloe, Joshua, Washini'ton 1892 1904

Bellevue Med. Coll., 1892.

X. C. MEDICAL SOCIETY. 847

BERTIE COUNTY SOCIETY.

Joined
Members and Address. Licensed, kilate

Society.

Tayloe, Armistead K., Aurora 1896 1896

Med. Coll., Va., 1897.

President, P. C. Jenkins, Roxobel 1904

Bellevue Med., 1873.
Secretary, .Jno. L. Pritcliard, Windsor 1906 1906

P. & S., Baltc, 1906.

Mitchell, Wavland, Lewiston 1896 1904

Univ. Md., 189.5.

Horton, E. H., Aulander 1885 1904

P. & S., Balto., 1884.

Harrell, W. J., Aulander 1885 1892

P. & S., Balto., 1884.

Nowell, Luther A., Colerain 1894 1905

Univ. Md., 1894.

Capehart, A., Roxobel 1887 1905

Balto. Md. Coll., 1887.

Ruffin, J. B., Powellsville 1906 1906

Univ. South, Sewanee, Tenn., 1898.

BLADEN COUNTY SOCIETY^

President, Geo. L. Clark, Clarkton 1904

Univ. N. Y., 1876.

Secretary, Newton Robinson, Elizabethtown 1904

Univ. Pa., 1809.

Evans, Dr. L. B., Clarkton 1900 1904

Univ. Coll. Med., 1900.

BURKE COUNTY SOCIETY.

President, .J. B. Riddle, Morganton 1904 1905

Vanderbilt, 1898.

Secretary, Louis G. Beall, Morganton 1906 1908

N. C. Med., 1906.

Anderson, Paul V., Morganton 1904 1906

Univ. Va., 1904.

Hall, James K., Morganton 1900 1906

Jeff. Med. Coll., 1904.

Henne^^see, E. A., Glen Alpina 1902 1904

U. S. Grant Univ., 1900.

McCampbell, John, Morganton 1895 1899

Balto. Md., 1894.

Phifer, E. W., Morganton 1902 1904

N. C. Med. Coll., 1901.

Taylor, Isaac M., Morganton 1883 1883

P. & S., N. Y., 1882.

Warlick, E. S., Morganton 1904

Univ. Tenn., 1881.

848 FIFTY-FIFTH ANNUAL SESSION

BUNCOMBE COUNTY SOCIETY.

Joined
Members and Address. Licensed. State

Society.

President, D. E. Sevier, Asheville 1895 1899

Jelf. Med., 189.5.

Secretary, G. S. Tennent, Asheville 1894 1898

N. C. Med. Coll., 1894.

Ambler, C. P., Asheville 1890 1891

West. Reserve Univ., 0., 1889.

Anderson, J. G., Asheville 1907 1908

Univ. N. C, 190G.

Archer, T. J., Black Mountain 1905 190fi

N. West Univ., 1896.

Ashworth, W. C, Asheville 1892

P. & S., Balto., 1902.

Battle, S. W., Asheville 1887

Bellevue, N. Y., 1875.

Briggs, H. H., Asheville 1901 1903

Yale Univ., 1897.

Brookshire, H. G., Asheville, R. F. D., 5 1905 1906

N. C. Med., 1905.

Brown, T. E. W., Asheville 1905 1904

P. & S., N. Y., 1900.

Brownson, W. C, Asheville 1896

Univ. N. Y., 1878.

Buckner, R. G., Asheville 1907 1908

Arkansas Univ., 1897.

Burroughs, J. A., Asheville 1884 1889

Louis. Med., 1882.

Calloway, A. W.. Asheville 1899 1904

Chi. Homeop. Med. Coll., 1875.

Carroll, R. S., Asheville 1905 1906

Rush Med. Coll., 1897.

Cheesborough, T. P., Asheville 1891 1899

Univ. N. Y., 1891.

Clomenger, F. L., Asheville 1903 1904

Univ. Denver, 1902.

Cocke, J. E., Asheville 1905 1906

Louis. Med. Coll., 1905.

Cotton, C. E., Black Mountain 1901 1901

Univ. Wooster, 0., 1889.

Dunn, W. L., Asheville 1900 1900

Univ. Mich., 1891.

Elias L. W., Asheville 1906 1906

P. & S., N. Y., 1903.

Fletcher, M. H., Asheville 1881 1881

Bellevue Med. Coll., 1881.

Glenn, E. B., Asheville 1896 1899

Jeff. Med., 1896.

Hennell, M. H., Asheville 1907 1908

Eclectic Med. Institute, Cincinnati, 1891.

N. C. MEDICAL SOCIETY. 849

Joined
Members and Address. Licensed. State

Society.

Johnson, A. E., Asheville 1905 1907

Womans Med. Col., Pa., 1905.

Jordan, C. S., Asheville 1891 1899 '

Univ. N. Y., 1890.

McBrayer, L. B., Asheville 1891 1899

Louis. Med. Coll., 1889.

McCrac'ken, C. M., Fairview 189G 1904

Non-graduate N. C. Med. Coll., 1896.

Manville, W. E., Asheville 1906 1908

George Washington Univ., 1904.

Meriwether, F. T., Asheville 1888 1888

Univ. Louis., Ky., 1886.

Merrinion, L. A., Asheville 1899 1904

Woman's Med. Coll., 1900.

Minor, C. L., Asheville 1895 1898

Univ. Va., 1888.

Morris, E. R., Asheville 1896 1899

Louis. Med. Coll.

Orr, C. C, Asheville 1904 1905

Univ. Md., 1904.

Orr, P. B., Asheville 1901 1904

JeiT. Med. Coll., 1901.

Paquin, P., Asheville 1899 1899

Univ. Mo., 1887.

Pritchard, A. T., Asheville 1905 1906

Jeff., Phila., 1905.

Furefoy, G. W., Asheville 1884 1904

Jeff., Phila., 1876.

Reynolds, C. V., Asheville 1895 1896

Univ. N. Y., 1895.

Reynolds, S. H., Asheville 1903 1903

Louis. Med. Coll., 1903.

Ringer, P. H., Asheville 1906 1907

P. & S., N. Y., 1904.

Ruck, K. von Asheville 1899 1902

Univ. Mich., 1879.

Ruck, S. H., von, Asheville 1899 1902

Bellevue, 1899.

Sawyer. J., Asheville 1897 1899

Bellevue Med. Coll., 1897.

Sevier, J. T., Asheville 1895 1899

Jeff. Med., 1895.

Smith, 0., Asheville 1905 1906

Jeff. Med., 1905.

Stevens, M. L., Asheville 1892 1893

Balto. Med., 1891.

850 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Weaver, H. B., Asheville 1881 1881

Wash. Univ. Med. Coll., Md., 1872.

Whittington, W. P., Asheville 1882 1882

P. & S., Balto., 1882.

Williams, J. H., Asheville 1881 1881

Univ. Iowa, 1862.

Eckel, 0. F., Swannanoa 1907 1908

Med. Coll. S. C, 1906.

Harris, I. A., Alexander, R. F. D. 2 1885 1881

1 Co. Jeff. Med. Coll.

Ragan, J. A., Weaverville 1881

Vanderbilt Univ., 1877.

Reed, C. E., Banner Elk 1902 1905

Jefferson Coll., 1905.

Zimmerman, C. St. V., Asheville 1903 1904

Nat. Univ., D. C, 1895.

Morse, L. B., Chimney Rock 1901 1901

Chicago Homop. Med. Coll., 1895.

Cassaway, S. F 1905 1906

Med. Coll. S. C, 1900.

Boyd, L., Montreat 1907 1908

Woman's Med. Coll., Balto., 1907.

BRUNSWICK COUNTY SOCIETY.

President, E. G. Goodman, El Paso 1891 1892

Univ. Md., 1891.

Secretary, J. Arthur Dosher, Southport 1903 1903

Balto. Med. Coll., 1903.

Watson, D. I., Southport 1890 1891

Univ. Louisville, Ky., 1890.

Moore, T. V., Phoenix 1901 1901

Balto. Med., 1901.

CABARRUS COUNTY SOCIETY.

President, D. G. Caldwell, Concord 1885 1885

Univ. Md.

Secretary, J. E. Smoot, Concord 1901 1902

Baltimore, Md.

Archey, L. M., Concord 1880 1888

P. & S., Balto.

Lafferty, J. S., Concord 1881 1890

Univ. Md.

Wallace, J. W., Concord 1907 1908

N. C. Med. Coll., 1907.

Black, J. C, Pioneer Mills 1886 1891

Univ. Md.

N. C. MEDICAL SOCIETY. 851

Joined
Members and Address. Licensed. State

Society.

Gouger, G. J., Concord 1891 1899

Univ. Md.

Young, R. S., Concord 1881 1882

N. Y. Univ. Med. Coll.

Pharr, Theo. F., Concord 1875 1881

Jeff. Med.

Pemberton, W. D., Concord 1887 1887

Univ. of Md., 1887.

Matthews, J. M., Mt. Pleasant 1899

Univ. Tenn.

King, R. M., Concord 1903 1905

Jeff. Med., 1903.

Rogers, F. O., Concord 1901 1901

Univ. Md., 1901.

Grier, S. A., Concord 1904

Jeff. Med. Coll., 1879.

Burleyson, L. N., Concord 1891 1904

Univ. Md., 1891.

Flower, J. W., Concord 1903 1904

N. C. Med., 1898.

Barrier, P. A., (honorary), Mt. Pleasant 1861 1861

Long Island Med. Coll., 1861.

Fail, M. A., Mt. Pleasant 1891 1908

Jeff. Med., 1891.

CALDWELL COUNTY SOCIETY.

President, A. A. Kent, Lenoir 1885 1904

Jeff. Med. Coll., 1885.

Secretary, W. P. Ivey, Lenoir 1885 1891

Univ. Md., 1885.
Mattocks, C. J., Lenoir 1904

Med. Coll., Va., 1864.
McNairy, C. B., Lenoir 1893 1905

P. & S., Balto., 1893.

Wilson, C. L., Lenoir 1903 1905

U. S. Grant Univ., 1903.

Moore, J. C, Lenoir 1907 1908

Richmond, 1907.

Carter, G. H., King's Creek, R. F. D 1904

Univ. N. Y., 1877.

White, W. M., Collettsville 1899 1904

P. & S., Atlanta, 1899.

Flowers, B. G., Granite Falls, R. F. D 1904

Non.-Grad. ; practice prior to 1885.

Corpening, O. J., Granite Falls 1906 1906

Univ. Coll. Med., Va., 1906.

852

FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Flowers, G. E., Granite Falls 1904

Ico. So. Med. Coll.

Stovy, J. G., Mortimer 1898 1908

Tenn. Med., 1898.

CARTERET COUNTY SOCIETY.

President, Geo. Davis, Beaufort 1902 1904

Ky. Sch. Med., 1906.

Secretary, K. P'. B. Bonner, IMorehead City 1905 1904

Med. Coll. Va., 1905.

Adams, L. C, Atlantic : 1903 190G

N. C. Med. Coll., 1903.
Clark, F. M., Beaufort 1894 1904

P. & S., Balto., 1894.

Duncan, C. L., Beaufort 1902 1904

Univ. Md., 1902.

George, D. S., Marshallburg 1903 1903

N. C. Med. Coll., 1903.
Headen, W. E., Morehead City 1890 1891

Univ. Md., 1891.
Paul, W. T., Stacey 1904

Univ. Md., 1809.

C. N. Mason, Harlowe 1904

P. & S., Balto., 1882.

CASWELL COUNTY SOCIETY.

President, S. A. Malloy, Yanceyville 1898 1903

Ky. School of Med., 1897.

Secretary, M. H. McBryde, Milton 1901 1904

Univ. Coll. Med., 1901.

Badgett, J. F., Blackwell's 1904

P. & S., Baltimore, 1881.

CATAWBA COUNTY SOCIETY.

President, J. T. Johnson, Hickory 1904

Univ. Pa., 1861.
Secretary, T. F. Stevenson, Hickory 1893 1905

Louis. Med. Coll., 1893.
Campbell, J. R., Newton 1898

Wash. Univ., Md., 1871.
Wilson, W. E., Sherrill's Ford 1886 1904

Louis. Med. Coll., 1886.
Abernathy, H. L., Hickory 1887 1904

Louis. Med. Coll., 1886.

Shuford, J. H., Hickory 1902 1902

Univ. Mich., 1901.

FIFTY-FIFTH ANNUAL SESSION

853

Joined
Memhers and Address. Licensed. State

Society.

Menzies, H. C, Hickory 1894 1894

N. C. Med. Coll., 1904.

^\^litesides, B. F., Hickory 1881 1881

Univ. Md., 1877.

Abernathy, W. L., Hickory 1879 1904

Ky. Sch. Med., 1877.

Long, F. Y., Catawba 1898 1904

N. C. Med. Coll., 1899.

Blackburn, T. C, Hickory 1896 1908

Baltimore Med. Coll., 1896.

Price, K. A., Hickory 1907 1908

Univ. Va., 1907.

CHATHAM COUNTY SOCIETY.

President, R. W. Palmer, Gulf 1891 1901

Louis. Med. Coll., 1890.
Secretary, H. T. Chapin, Pittsboro 1886 1886

Louis. Med. Coll., 1890.

Burns, William, Goldstone 1905

Col. P. & S., Balto., 1878.
Edwards, J. D., Siler City 1894

Louis. Med. Coll., 1887.

Kirkman, T. A., Lindhurst 1905

*Taylor, J. N., Pittsboro 1902 1902

Med. Coll. Va., 1901.

CHEROKEE COUNTY SOCIETY.

President, J. F. Abernathy, Murphy 1885 1904

Ky. School Med., 1883.

Secretary, S. C. Highway, Murphy 1904 1904

Med. Coll. Ohio, 1885.

Casteel, L. R. Culbertson 1906 1906

Vanderbilt Univ., 1893.

Orr, R. J., Andrews 1904

Louisville Med. Coll., 1893.

Patton, W. 0., Murphy 1904

Coll. P. & S., Balto., 1883.

Webb, B. G., Andrews 1885 1904

Louisville Med. Coll., 1885.

CLEVELANT) COUNTY SOCIETY.

President, W. T. Grigg, Shelby, R. F. D 1904 1904

Atlanta Med. Coll., 1891.

Secretary, B. H. Palmer, Shelby 1898 1904

Louisville Med. Coll., 1896.

854 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Ellis, R. C, Shelby 1904

Univ. of Balto., 1886,

Lee, L. V., Lattimore 1897 1904

Atlanta Med. Coll., 1894.

Mitchell, W. F., Shelby 1900 1904

University of Md., 1899.

McKay, J. L., Kings Mountain 1904

University Phila., 1870.

Royster, S. S., Mooresboro 1896 1904

Tenn. Med., 1890.

Wood, J. W., Shelby, R. P. D 1903 1904

Aydlette, J. P., Earls 1903 1904

University Ky., 1901.

Champion, C. O., Mooresboro 1902 1904

Atlanta Med. Coll., 1887.

Oats, Geo., Grover 1896 1904

Univ. Louisville, Ky., 1894.

Lattimore, E. B., Shelby 1896 1908

Bellevue Med. Coll., 1898.

McBrayer, T. E., Shelby 1904

Washington Univ., 1875.

Morrison, R. R., Shelby 1907 1908

N. C. Med. Coll., 1907.

COLUMBUS COUNTY SOCIETY.

President, W. F. Smith, Chadbourn 1904 1905

N. C. Med. Coll., 1904.

Secretary, S. M. Withers, Chadbourn 1902 1902

N. C. Med. Coll., 1902.

Blake, J. F., Chadbourn 1905 1906

N. C. Med. Coll., 1905.

Crowell, W. H., Burgaw 1895 1896

Univ. of Med., 1895.

Floyd, A. G., Fair Bluff 1904

Univ. Md., 1885.
Maxwell, F. B., Whiteville 1902 1902

Univ. Md., 1902.

Jordan, D. B., Cronly 1904

Jeff. Med., 1885.

Johnson, T. C, Vineland 1903 1905

Med. Coll. Va., 1903.

CRAVEN COUNTY SOCIETY.

President, Francis Duffy, New Bern 1872 1872

Univ. Va., 1868.

Secretary, Joseph T. Patterson, New Bern 1906 1906

Jeff. Med. Coll., 1906.

N. C. MEDICAL, SOCIETY. 855

Joined
Members and Address. Licensed. State

Society.

Duffy, Chas., New Bern 1870

Univ. N. Y., 1859.

Primrose, R. S., New Bern 1890 1904

Bellevue Med. Coll., 1889.

Hughes, F. W., New Bern "... 1885 1904

Univ. Pa., 1880.

Jones, R. D. V., New Bern 1897 1904

Univ. Md., 1896.

Duffy, L., New Bern 1889 1906

P. & S., Balto., 1889.

Rhem, J. F., New Bern 1893 1904

Bellevue Med. Coll., 1894.

Gibbs, N. M., New Bern 1895 1907

Univ. of Md., 1896.

Caton, G. A., New Bern 1898 1904

Med. Coll. Va.. 1898.

CUMBERLAND COUNTY SOCIETY.

President, J. V. McGougan, Fayetteville 1893 1904

Univ. Med. Coll., 1893.

Secretary, Wm. S. Jordan, Fayetteville 1906 1906

Univ. of N. C, 1906.

Hammond, A. F., Pollocksville 1903 1905

Univ. Med. Coll., Ya., 1903.

Duffy, R. N., New Bern 1907 1908

Johns Hopkins, 1906.

Street, N. H., New Bern 1883 1884

Univ. of N. Y., 1881.

Pollock, Raymon, Dover 1900 1900

Jeff. Med. Coll.. 1897.

Averitt, K. G., Cedar Creek 1893 1902

Balto. Med. Coll., 1893.

Brown, Geo. W., Raeford 1900 1904

Ky. School of Med., 1898.

Bullock, T. C, Autry\ille 1885 1904

P. & S., Balto., 1885.

Dye, John C, Fayetteville 1905 1906

N. C. Med. Coll., 1905.

Graham, Geo. A., Raeford 1904

Univ. of N. Y., 1876.

Highsmith, J. F., Faj'etteville 1889 1893

Jeff. Med. Coll., 1889.

Highsmith, Seary, Fayetteville 1901 1902

Univ. Coll. Med., Va., 1901.

Jordan, Wm. S., Fayetteville 1906 190G

Univ. of N. C, 1906.

Lilly, J. M., Fayetteville 1903 1904

Univ. Coll. Med., Va., 1903.

856 FIFTY-FIFTH ANNUAL SESSION

Joined
Memhers and Address. Licensed. State

Society.

Marsh, J. H., Fayetteville 1889 1890

Jeff. Med. Coll., 1889.

McGongan, J. V., Fayetteville 1893 1904

Univ. of Med., Balto., 1893.

McKethan, John A., Fayetteville 1901 1904

N. C. Med. Coll., 1901.

McNeill, J. W., Hope Mills 1876 1876

Bellevue Hosp. Med. Coll., 1876.

Olive, P. W., Wade 1907 1908

P. & S., Balto., 1907.

Rose, A. S., Fayetteville 1901 1904

Univ. Coll. Med., Va., 1901.

Willingham, B. J., Hope Mills 1907 1908

Med. Coll of Va.. 1906.

Thornton, Irene, Fayetteville 1908 1908

Woman's Med. Coll. of Balto., Md., 1908.

CURRITUCK COUNTY SOCIETY.

President, H. M. Shaw, Shawboro 1904

Univ. Med., 1871.

Secretary, Stuart M. :Mann, Moyock 1885 1904

P. & S., Balto., 1885.

Ritter, F. W., Movoek 1885 1885

' One Course P. & S., Balto., 1885.

Griggs, W. T., Poplar Branch 1896 1901

Univ. Va., 1896.

Newbern, J. :\L, Jarvisburg 1899 1904

Georgetown Univ., 1898.

Garrington, J. F., Coinjock 1904

Bauni, Julian Coralla 1907

DAVIDSON COUNTY SOCIETY.

President, E. J. Buchanan, Lexington 1892 1900

Univ. Md., 1892.

Secretary, D. J. Hill Lexington 1893 1894

P. & S., Balto., 1893.

Vestal, W. J., Lexington 1893

P. & S., Balto., 1883.

Clodfelter, C. M., Lexington 1905 1906

P. & S., Balto., 1905.

Hill, Joel, Lexington 1885 1886

P. & S., Balto., 1880.

Myers, J. A., Linwood, No. 2 ....

Cathell, J. E., Linwood, No. 1 1902 1902

Univ. Md. 1899.

Hill, W. Lee, Lexington, No. 4 1893 1904

P. & S., Balto., 1893.

N. C. MEDICAL, SOCIETY. 857

Joined

Members and Add7'ess. Licensed. State

Society.

Zimmerman, E. U. Lexington, No. 4 1901 1904

N. C. Med. Coll., 1901.

Julian, C. A., Thomasville 1891 1893

Louis. Med. Coll., 1888.

Mock, J. H., Thomasville 1898 1904

Med. Coll. Va., 1898.

Peacock, J. W., Thomasville 1901 1905

Tulane Univ., 1901.

Anderson, A., Denton 1904

York, A. A. Linwood, R. F. D. No. 2 1907 1908

Chatt. Med. Coll., 1907.

Mock, Frank L., Lexington 1908

DAVIE COUNTY SOCIETY.

President, M. D. Kimbrough, Mocksville 1904

Univ. Pa., 1860.

Secretary, W. C. Martin, Mocksville 1888 1904

P. & S., Balto., 1888.

Rodwell, J. W., Mocksville 1895 1896

P. & S., Balto., 1896.

Martin, J. F., Advance, R. F. D 1908

Watkins T. T., Advance 1896 1896

N. C. Med. Coll., 1896.

Bjerly, A. B., Cooleemee 1896 1904

Univ. Coll. Med., 1896.

DUPLIN COUNTY^ SOCIETY.

President, Jno. M. Faison, Faison 1885 1885

Univ. Va., 1885.

Secretary, B. R. Graham, Wallace 1895 1899

Univ. Va., 1895.

Hatcher, T. R., Rose Hill

P'errell, J. A., Kenansville 1907 190r»

Univ. N. C, 1902.

Williams, J. M., Warsaw 1902 1902

Univ. Md., 1902.

Hussey, L., Warsaw 1904

Univ. Pa., 1853.

Lane, Jno. L., Warsaw 1906 1906

N. C. Med. Coll., 1906.

Landen, J. F., Chinquapin 1905 1907

Univ. Coll. Med., 1905.

Carroll, J. W., Wallace 1903 1903

Univ. Md., 1903.

Carr, R. L., Magnolia 1908 1908

Balto. Med. Coll., 1907.

858 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.
DURHAM COUNTY SOCIETY.

President, Arch. Cheatham, Durham 1888 1888

Univ. Md., 1888.
Secretary, C. A. Woodard, Durham 1904 1907

Univ. Va., 1904.

Adams, C. A., Durham 1892 1905

Coll. P. & S., Balto., 1892.

Boddie, N. P., Durham 1883 1883

Coll. P. & S., Balto., 1883.

Bowling, E. H., Durham 1890 1908

Coll. P. & S., Balto., 1891.
Brooks, B. U., Durham 1905 190S

Univ. Md., 1905.
Felts, R. L., Durham 1899 1908

Univ. Md., 1898.
Graham, Jos., Durham 1902 1906;

Univ. Pa. 1901.
Graham, W. A., Durham 1901 1901

Univ. Pa., 1899.

Hicks, Wm. N., Durham 1885 1901

Med. Coll. Va., 1864.
Hicks, C. S., Durham 1904 1904

Univ. Md., 1904.

Hollowav, R. L., West Durham 1893 1904

Med. Coll. Va., 1893.

Johnson, N. M., Durham 1879 1904

Wash. Univ. Md., 1876.

Jordan, A. C, Durham 1885 1904

Coll. P. & S., Balto., 1881.

Manning, J. M., Durham 1884 1891

Bellevue Med. Coll., 1882.

Mann, T. A., Durham 1903 1903

Univ. Md. 1903.

Moore, R. A., Durham 1897 1893

Univ. Md., 1891.

O'Kelly, J. M., Durham 1884 1883

Ky. School Med., 1877.

Olive, W. W., Durham 1907 1908

Univ. Md., 1906.

Ross, Geo. H., East Durham 1899 1904

Univ. Tenn., 1899.

Smith, J. A., Durham 1884 1905

Univ. N. Y., 1883.

Teague, R. J., Durham 1890 1898

Univ. Md., 1890.
Ward, M. P., HoUoway 1904

rr. C. MEDICAL, SOCIETY. 859

Joined
Members and Address. Licensed. State

Society.

EDGECOMBE COUNTY SOCIETY.

President, J. J. Phillips, Tarboro 1905 1905

P. & S., N. Y., 1894.

Secretary, S. N. Harrell, Tarboro 1907 1904

Univ. Md., 1897.

Staton, L. L., Tarboro 1870 1900

Univ. N. Y., 1870.

Baker, J. M., Tarboro 1879 1879

Univ. Md. 1879.

Thigpen, W. J., Tarboro 1900 1901

Jeff. Med. Coll., 1900.

Mercer, W. P., Elm City 1879 1904

Univ. N. Y., 1879.

Bass, S. P., Tarboro 1907 1908

Univ. Va., 1906.

Speight, J. P., Whitakers, R. F. D 1905 1908

Jeff. Med. Coll., 1905.

Walton, C. B. Macclesfield 1893 1907

Univ. Md., 1893.

Brothers, J. E., Conetoe 1906

Bellevue Med. Coll., 1874.

FORSYTH COUNTY SOCIETY.

President, D. N. Dalton, Winston-Salem 1885 1886

Univ. N. Y., 1881.

Secretary, E. P. Gray, Winston-Salem 1907 1908

Johns Hopkins Med. Sch., 1906.

Summers, C. L., Winston-Salem 1891 1896

• Univ. Md., 1887.

Fearrinfrton, J. P., Winston-Salem 1887 1904

Univ. Md., 1887.

Spencer, W. 0., Winston-Salem 1891 1894

Jefferson Med., 1891.

Shaffner, J. F., Jr., Winston-Salem 1900 1903

Univ. Va., 1899.

Bynum, Jno., Winston-Salem 1892 1896

Univ. N. Y., 1892.

Kapp, H. H., Winston-Salem 1901 1904

Jeff. Med.' Coll., 1901.

Pfohl, S. F., Winston-Salem 1898 1898

Univ. Pa., 1894.

Bahnson, H. T., Winston-Salein 1869 1869

Univ. Pa., 1807.

Jewett, R. D., Winston-Salem 1890 1890

Univ. Va., 1888.

Lott, H. S., Winston-Salem 1888 1888

Univ. Ga., 1884.

860

FIFTY-FIFTH ANNUAL SESSION

Members and Address. Licensed.

Wright, J. T., Winston-Salem 1892

P. & S., Balto., 1892.

Spainhour. E. H., Winston-Salem 1898

Balto. Med. Coll., 1898.

Davis, A. P., Winston-Salem 1896

Ky. Sch. Med., 1894; Geo. Wash. Univ., 1906.

Strickland, E. F., Bethania 1887

Univ. N. Y., 1887.

Hammock, J. C, Walkertown 1895

P. &. S., Balto., 1895.

Hanes, J. L. Winston-Salem 1902

Univ. Md., 1902.

Byniim, Wade H., Germanton 1900

Univ. Coll. Med., Va., 1900.

Linville, A. Y., Winston-Salem 1889

Univ. N. Y., 1889.

Williams, J. D., Lewisville 1898

Vanderbilt, 1898.

Lockett, E. A., Winston-Salem 1904

Univ. Pa., 1902.

Copple, I. M., Winston-Salem 1899

Univ. Md., 1900.

Davis, J. W., Vienna 1903

Med. Coll. Va., 1903.

Dalton, W. N., Winston-Salem

Justice, J. T., Kernersville 1904

N. C. Med. Coll., 1904.

Carlton. R. L., Kernersville 1906

Univ. Md., 1906.

Davis, T. W., Winston-Salem

Flynt, S. S., Rural Hall 1890

P. & S., Balto., 1889.

Shaffner, J. F., Sr., Winston-Salem (Hon.)

Jeflf. Med. Coll., 1860.

Fulp, E., Fulp (Stokes Co.), (Hon.)

Univ. of N. Y., 1882.

Griffith, J. F., Clemmonsville

Pepper J. K., Winston-Salem 1908

Coll. P. & S., Balto., 1907.

Hammock, J. C, Walkertown 1905

Coll. P. & S., Balto., 1905.

FRANKLIN COUNTY SOCIETY.

President, J. E. Malone, Louisburg

Bellevue Med., 1875.
Secretary, S. P. Burt, Louisburg 1896

P. & S., Balto., 1896.

Joined

State

Society.

1904
1898
1904
1903
1907
1902
1900
1896
1898
1904
1905
1905

1906
1867
1896

1908
1908

1904
1904

N. C. MEDICAL SOCIETY. 861

Joined
Members and Address. Licensed. State

Society.

Yarborough, R. F., Louisburg 1899 1899

Columbia Univ., D. C, 1898.

Newell, H. A., Louisburg 1906 190G

P. & S., Balto., 190G.

Mann, J. J., Louisburg 1886 1904

Xon-grad. Balto. Med.
Flovil, R. P., Louisburg, R. F. D. No. 1 1904

S. C. Med. Coll., 1878.

Bobbitt, E. H., Louisburg, R. F. D. No. 4 1885 1908

Univ. Md., 1883.

Henderson, R. B., Franklinton 1887 1904

Univ. Md., 1887.
Harris, J. H., Franklinton 1887 1904

Bellevue Med., 1887.
Wheless, J. R., Centerville 1891 1904

P. & S., Balto., 1891.

GASTON COUNTY SOCIETY.

President, J. M. Sloan, Gastonia 1891 1904

Louisville Med. Coll., 1891.

Secretary, H. F. Glenn, Gastonia 1900 1904

P. & S., Atlanta, 1900.

Adams, C. E., Gastonia 1885 1904

Univ. Md., 1878.

Anders, McT. G., Gastonia 1902 1902

Md. Med. Coll., 1901.

Davis, W. W., Belmont 1904

Ky. School Med., 1875.

Eddleman, H. M., Gastonia 1904

Ky. School Med., 1886.

Garren, R. H., Bessemer 1901 1904

Univ. of Nashville, 1900.

Garrison, D. A., Bessemer City 1896 1899

Louisville Med. Coll., 1896.

Hunter, M. C, Stanley 1882 1904

P. & S., Balto., 1882.

Jenkins, J. H., Dallas 1888 1904

Ky. School Med., 1888.

McLain, Chas. E., Gastonia 1904 1905

N. C. Med Coll., 1903.

Patrick, G. R., Lowell 1904

Univ. Md., 1879.

Quickel, T. C, Stanley 1899 1904

Tulane Univ., 1899.

Reid, R. M., Gastonia 1890 1903

Univ. N. Y., 1890.

Robinson, Frank, Lowell 1881 1904

Louisville Med. Coll., 1878.

862 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Sloan, J. M., Gastonia 1891 1904

Louisville Med. Coll., 1891.

Wilkins, S. A., Dallas 1903 1903

Univ. Ky., 1902.

Wilson, F. G., Gastonia 1896 1899

Univ. Md., 1896.

McCorabs, C. J., King's Mountain 1905 1908

N. C. Med. Coll., 1905.
Rhyne, E. E. O., Mt. Holly 1908

GRAHAM COUNTY SOCIETY.

President, M. F. Maxwell, Robbinsville 1904

Southern Med. Coll., 1885.

Secretary, G. F. Brock, Brock 1904

Registered on oath.

Howell, S. F., Robbinsville 1904

Registered on oath.

Hooper, L. D., Robbinsville, R. F. D 1904

Registered on oath.

GATES COUNTY SOCIETY.

President, Geo. D. Williams, Gatesville 1897 1904

P. & S., Balto., 1897.

Secretary, Geo. C. Brooks, Sunbury 1904

P. & S., Balto., 1884.

Corbell, E. F., Sunbury 1893 1900

Univ. Md., 1886.

Lee, W. O. P., Reynoldson 1904

P. & S., Balto., 1874.

GREENE COUNTY SOCIETY.

President, Albert West, Speight's Bridge 1904

Cincinnati Med. Coll., 1887.

Secretary, G. C. Edwards, Hookerton 1883 1883

Bellevue, N. Y., 1883.

Murphy, W. B., Snow Hill 1903 1905

Univ. Med. Coll., Va., 1903.

Harper, J. H., Snow Hill 1906 1906

Jeff. Med. Coll., 1906.

Whittington, W. W., Snow Hill 1895 1897

Louisville Med. Coll., 1895.

Stamey, E. L., Ormondsville 1895 1904

Atlanta Med., 1895.

GRANVILLE COUNTY SOCIETY.

President, S. D. Booth, Oxford 1885 1885

1 Course Med. Coll., Va., 1867.

N. C. MEDICAL SOCIETY.

863

Joined
Members and Address. Licensed. State

Society.

Secretary, Benj. K. Ha vs, Oxford 1894 1896

Univ. Coll. Med., Va., 1894,

Coggeshall, G. A., Oxford 1879 1894

Bellevue Med. Coll., 1879.
Meadows, E. B., Oxford, R. F. D. No. 1 1901 1901

Univ. Coll. Med., 1901.
Morris, J. A., Oxford, R. F. D., No. 2 1893 1899

Vanderbilt Univ., 1893.

Sanderford, J. F., Creedmoor 1890 1891

P. & S., Balto., 1890.

Watkins, G. S., Oxford 1900 1908

Univ. Coll. Med., Va., 1900.

Hardee, P. R., Stem 1885 1906

P. & S., Balto., 1885.

Sikes, G. T., Grissom 1884 1884

Univ. Md., 1884.

GUILFORD COUNTY SOCIETY.

President, J. R. Williams, Greensboro 1904 1904

Univ. Mich., 1903.

Secretary, E. Harrison, Greensboro 1900 1900

Univ. Coll. Med., 1896.

Armfield, D. A., Jamestown 1889 1904

Jeff. Med. Coll., 1861.

Banner, C. W., Greensboro 1899 1901

Univ. Med., 1899.

Battle, J. T. J., Greensboro 1884 1889

P. & S., Balto., 1884.

Beall, W. P., Greensboro 1879 1879

Jeff. Med., 1879.

Brooks, J. E., Greensboro 1897 1904

Univ. Coll. Med., Va., 1897.

Brooks, Z. T. Greensboro 1901

Jefferson, 1868.

Boyles, J. H., Greensboro 1903 1904

P. & S., Balto., 1903.

Bowman, W. P., Greensboro 1894 1904

Univ. of Tenn., 1894.

Burrus, J. T., High Point 1897 1898

Grant Univ., 1898.

Coble, W. A., Hartshorn 1889 1907

Jeff. Med. Coll., 1889.

Davis, W. C, Summerfield 1889 1904

Univ. Balto., 1896.

Dees, R. O., Greensboro 1907 1908

Univ. of Md., 1906.

Dick, J. v., Gibsonville 1907 1908

Univ. of N. C, 1907.

864 riFTY-riFTii annual session

Joined
Members and Address. Licensed. State

Society.

Dodson, H. H., Greensboro 1885 1886

Med. Coll. of Va., 1882.

Duncan, G. F., High Point 1898 1907

Balto. Univ. S. of Med., 1902.

Farrar, M. E., Greensboro 1905 1906

Univ. N. C, 1905.

Fortune, A. F., Greensboro 1900 1904

Univ. Coll. Med., 1900.

Foscue, J. E., Jamestown 1903 1907

Univ. of Md., 1903.

Fox, M. F., Guilford College 1885 1885

P. & S., Balto., 1881.

Gilmer, C. S. Greensboro, E. F. D 1891 1894

Univ. N. Y., 1891.

Glascock, J. H., Greensboro 1896 1898

Woman's Med. Coll., Balto., 1896.

Gordon, J. E., Jamestown 1896 1894

P. & S., Balto., 1891.

Gove, A. M., Greensboro 1894 1905

Woman's Med. Coll., N. Y., 1891.

Gray, C, Pleasant Garden 1904

Grayson, C. S., High Point 1907 1908

Geo. Wash. Univ., 1906.

Grimsley, J. E., Greensboro 1883 1884

Univ. Va., 1883.

Hilton, J. J., Greensboro 1889 1904

Univ. Md., 1886.

Holt, J. T., McLeansville 1906

Jarboe, J. P., Greensboro 1906 1907

Georgetown, 1905.

Jones, J. W., Brown Summit 1889 1904

Mo. Med. Coll., 1875.

Jones, W. M., High Point 1905 1906

Univ. Md., 1903.

Jordan, G. E., Gibsonville 1891 1904

P. & S., Balto., 1891.
Kernodle, G. W., Greensboro, R .F. D 1886 1905

P. & S., Balto., 1886.

Knight, W. P., Greensboro, E. F. D 1898 1898

Balto., Med. Coll., 1898.

Ledbetter A. E., Greensboro 1888 1904

Univ. Md., 1888.

Little, T. E., Greensboro 1903 1903

Univ. Pa., 1900.

Logan, J. E., Greensboro 1889 1905

Jeff. Med. Coll., 1905.

Long, J. W., Greensboro 1884 1884

Vandervilt Univ., 1883.

N. C. MEDICAL SOCIETY. 865

Joined
Members and Address. Licensed. State

Society.

McAnally, W. J., High Point 189C 1899

Balto. Med. Coll., 1897.

Meadows, W. J., Greensboro 1899 1904

Med. Coll. Ala., 1894.

Michaux, E. R., Greensboro 1889 1904

Univ. N. Y., 1889.

Miles, M. S., Greensboro 1904 1905

Worn. Med., Cin., 0., 1898.

Moseley, C. W., Greensboro 1893 1896

Balto. Med. 1893.
Reaves, W. P., Greensboro 1905 1907

Univ. of So., 1903.

Reitzel, C. E., High Point 1902 1902

P. &. S., Ga.

Reitzel, J. R., High Point 1895 1896

Univ. Tenn., 1892.

Richardson, W. J., Greensboro 1889 1904

JeiT. Med. Coll., 1889.

Roberson, Chas.. Greensboro 1897 1901

Long Is. Med. Coll., 1897.

Scott, C. L., Greensboro 1899 1903

Univ. Md., 1897.

Stanton, D. A., High Point 1887 1891

Vanderbilt Univ. 1887.

Tankersley, J. W., Greensboro 1906 1907

Jeff. Med. Coll., 1906.

Turner, J. A., High Point 1889 1891

Louisv. Med. Coll., 1886.

Turner, J. P., Greensboro 1897 1904

Univ. Md., 1896.

Wells, J. M., Pleasant Garden 1905 1907

Univ. of N. C, 1905.

Whittaker, A. C, Julian 1903 1908

Univ. Tenn., 1903.

Williams, J. A., Greensboro 1898 1898

Univ. Va., 1898.

Wilson, A. R., Greensboro 1882 1882

Jeff'. Med. Coll., 1882.

Rieves, J. T., Greensboro 1892 1894

Louisv. Med. Coll., 1891.

Paddison, J. R., Oak Ridge 1902 1904

Univ. Md., 1902.

Norman, G. W., Pomona 1896 1908

Balto Med. Coll., 1896.

Williams, B. B., Greensboro 1886 1908

Univ. Md., 1883.

866 FIFTY-I'IFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.
HALIFAX COUNTY SOCIETY.

President, John A. Collins, Enfield 1880 1904

Bellevue Med. Coll., 1869.

Secretary, A. S. Harrison, Enfield 1888 1904

Univ. Md., 1888.

Ferguson, H. B., Halifax 1882 1904

Jeff. Med. Coll., 1882.

Green, J. E., VVeldon 1873 1904

Leggett, K., Hobgood 1885 1885

Ky. School Med., 1884.

Pierce, S. B., Roanoke Rapids 1897 1905

Bellevue Med. Coll., 1897.

Ky. School Med., 1893.

Zollicoffer, A. B., Weldon 1904

Univ. Pa., 1875.

Zollicoffer, D. B., Weldon 1886 1904

P. & S., Balto., 1886.
Hyatt, O. C, Wayeross, Ga 1908

HARNETT COUNTY SOCIETY.

President, F. T. Moore, Benson 1904

P. & S., Balto., 1885.

Secretary, S. P. J. Lee, Dunn 1904 1905

Md. Med. Coll., 1904.

Highsmith, Chas., Dunn 1898 1898

Balto. Med., 1898.

Sexton, C. H., Dunn 1890 1904

Univ. Md., 1890.

Denning, O. L., Dunn 1897 1904

Jeff. Med. Coll., 1889.

Hudson, W. L., Dunn 1883 1894

Ky. School Med., 1876.

Hicks, I. F., Dunn 1902 1904

N. C. Med. 1902.

Holt. Wm. P., Duke 1895 1901

Jeff. Med. Coll., 1895.

Boyles, A. C, DuVV. 1904 1908

Univ. Md.

McKay, J. F., Buie's Creek 1885 1904

S. C. Med. Coll., 1884.

Halford, J. W., Chalybeate Springs 1905 1906

Columbian Univ., Washington, D. C, 1904.

Arnold, L. J., Lillington 1905 1906

N. C. Med. Coll., 1905.

Melvin, W. C, Linden 1900 1905

Univ. Coll. Med., Va., 1900.

N. C. MEDICAL SOCIETY. 867

Joined
Members and Address. Licensed. State

Society.

Smith, F., Linden ■- 1905

S. C. Med. Coll., 1868.

Utley, H. H., Coats 1906 1907

Balto. Med. Coll., 1906.

McLean, J. W., aodwin 1902 1902

N. C. Med., 1902.

Rowland, W. H., Benson 1904

Non-graduate.

HAYWOOD COUNTY SOCIETY.

President, R. L. Allen, Waynesville 1885 1899

Univ. Md., 1885.

Secretary, J. Howell Way, Waynesville 1885 1886

Vanderbilt Univ., 1886.

Able, J. F., Waynesville 1893 1899

Univ. Balto., 1892.

Davis, F. M., Clyde 1894 1904

Vanderbilt Univ., 1894.

McCracken, J. R., Waynesville 1902 1903

N. C. Med., 1902.

Mease, J. H., Canton 1893 1894

Vanderbilt Univ., 1893.

Greenwood, B. H., Waynesville 1894 1906

Balto. Med., 1893.

Graham, W. A., Frie's Creek ....

Vanderbilt Univ., 1 Co. Registered on oath, 1906.

Rich, John Calvin, Dellwood 1908 1908

Univ. of Nashville, 1908.

Stringfield, Thomas, Waynesville 1898 1899

Vanderbilt Univ., 1898.

Stringfield, S. L., Waynesville 1905 1906

Jeff. Med. Coll., 1905.

Willis, A. P., Canton 1905 1906

Univ. N. C, 1905.

Wilson, J. E., Sonoma 1903

1 Co. Louisv. Med. Coll., 1876.

Hyatt, Fred. C, Canton 1907 1907

Jeff. Med. Coll., 1907.

Rogers, McLean Gear, Okla 1902 1905

P. & S., Atlanta, 1902.

Moore, J. E., Canton 1898 1899

Tenn. Med., 1899.

Kirkpatrick, Wm. L., Pacolet, S. C 1894 1895

Vanderbilt Univ., 1894.

McFayden, H. L., Waynesville 1904

Univ. N. Y., 1876.

868 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.
HENDERSON-POLK COUNTY SOCIETY.

President, Guy E. Dixon, Hendersonville 1903 1903

St. Louis. Coll. of P. & S., 1903.

Secretary, J. Steven Brown, Hendersonville 1894 1895

Northwestern Univ., 1893.

Allen, T. A., Hendersonville 1904

S. C. Med. Coll.

Few, C, Hendersonville 1904

Univ. Md., 1875.

Egerton, J. L., Hendersonville 1890

Univ. Md., 1877.

Drafts, A. B., Hendersonville 1899 1903

Univ. Va., 1896.

Kirk, Wm. R., Hendersonville 1901 1903

Central Univ. of Ky., 1890.

Waldrop, J. G., Hendersonville 1891

P. & S., Balto., 1876.

Howe, W, B. W., Hendersonville 1907 1908

Med. Coll. of S. C, 1906.

Grady, Earle, Tryon 1895 1899

Univ. Md., 1894.

Greenwood, S. E., Fletcher 1903 1904

Tenn. Med. Coll., 1902.

Russell, L. P., Fletcher 1902 1903

Univ. Nashville, 1901,

Salley, E. M., Saluda 1905 1906

Univ. Md., 1905.

Hood, J. S., Horseshoe 1907 1908

JeflF. Med. Coll., 1907.

Guerrard A. R., Flat Rock 1902 1905

Bellevue Med. Coll., 1895.

HERTFORD COUNTY SOCIETY.

President, C. F. Griffin, Winton 1893 1900

P. & S., Balto., 1893.

Secretary, A. W. Greene, Ahoskie 1904 1905

Univ. Coll. Med., Va., 1904.

Pollard, W. B., Winton 1893 1905

P. & S., Balto., 1893.

Freeman, W. G., Murfreesboro 1904

Univ. Pa., 1861.

Burbage, T. J., Como 1905

Memphis Hosp. Coll. Med., 1882.

Gary, R. H., Murfreesboro 1904

P. & S., Balto., 1881.

Mitchell, J. H., Ahoskie 1904

P. & S., Balto., 1879.

N. C. MEDICAL SOCIETY. 869

Joined
Members and Address. Licensed. State

Society.

Mitchell, Paul, Ahoskie 1907 1908

Univ. Coll. Med., Va., 1907.

Ward, J. E., Harrellsville 1904 1905

Univ. Md., 1904.

HYDE COUNTY SOCIETY.

President, E. H. Jones, Swan Quarter, R. F. D ....

Washington Univ., 1872.

Secretary, John W, Williams, Scranton 1906 1907

Univ. Md., 1906.

Windley, R. E., Lake Landing 1904 1907

Univ. Md., 1903.

Mann, J. A., Fairfield ....

Univ. N. Y. City, 1872.

Harris, A. G., Fairfield 1907 1908

Univ. of South, 1905.

Mann, J. E., Lake Landing 1908 1908

Univ. Md., 1907.

IREDELL-ALEXANDER COUNTY SOCIETY.

President, Thos. E. Anderson, Statesville 1879 1879

Jeff. Med. Coll., 1878.

Secretary, J. E. McLaughlin, Statesville 1886 1896

Univ. Md., 1886.

Adams, M. R., Statesville 1884 1884

Univ. Md., 1878.

Bell, A. E., Mooresville 1897 1904

Univ. Md., 1889.

Cloaninger, L. V., New Stirling 1901 1904

N. C. Med. Coll., 1901.

Hall, E. A., Statesville, R. F. D. No. 4 1904

Univ. of Md., 1868.

Jurnev, P. C, Turnersburg 1901 1904

Med. Coll. Va., 1901.

Klutz, E. E., Troutman 1896

Med. Coll. Va., 1884.

King, J. E., Statesville, R. F. D. No. 5 1904

Jeff. Med. Coll., 1868.

Long, H. F., Statesville 1892 1899

Univ. Md., 1892.

Moore, N. G., Mooresville 1891 1904

Jeff. Med. Coll., 1891.

Moore, J. T., Mooresville, R. F. D. No. 2 1898 1905

N. C. Med., 1898.

Nicholson, W. G., Harmony 1904

Louisv. Med. Coll., 1881.

870 FIFTY-FIFTH ANNUAL SESSION

JOHNSTON COUNTY SOCIETY.

Joined
Members and Address. Licensed. State

Society.

Stevenson, S. W., Mooresville 1879 1904

Wash. Univ., Md., 1873.

Yount, E. M., Statesville 1902 1902

N. C. Med. Coll., 1902.

Houck, Albert, Statesville 1891 1893

P. & S., Balto., 1884.

Sharpe, F. L., Statesville 1904 1905

Univ. Coll. Med., 1904.

Carpenter, F. A., Mooresville 1906 1907

N. C. Med. Coll., 1906.

Campbell, Arch., Statesville 1891 1905

Univ. Md., 1899.

Campbell, R. A. (U. S. Navy), Statesville 1897 1908

N. C. Med. Coll., 1897.

Hill, W. J., Statesville 1891 1908

Univ. Md., 1889.

JACKSON COUNTY SOCIETY.

President, A. A. Nichols, Painter 1904 1904

Univ. Nashville, 1898.

Secretary, D. D. Hooper, Sylva 1905 1905

Univ. Coll. Med., Va., 1905.
Candler, Chas. Z., Dillsboro 1901 1904

P. & S., Atlanta, 1901.

Candler J. M., Dillsboro 1904

Self, Wm., Webster 1904

President, A. H. Rose, Smithfield 1906 1906

Jeff. Med. Coll., 1906.
Secretary, G. D. Vick, Selma 1906 1906

Jeff. Med. Coll., 1906.

Wharton, L. D., Smithfield 1893 1894

Tulane Univ., 1893.

Hooks, Thel, Smithfield '. 1901 1903

Med. Coll. Va., 1901.

Robinson, G. J., Smithfield 1884 1884

Jeff. Med. Coll., 1882. ,

Mimms, L. A., Smithfield 1888 1904

P. & S., Balto., 1888.

Young, J. J., Clayton 1896 1904

P. & S., Balto., 1896.

Griftin, J. A., Clayton 1905

P. & S., Balto.

Hocutt, B. A., Clayton 1906 1907

Univ. N. C, 1906.

Stanlev, J. H., Four Oaks 1904 1906

Univ. N. C. 1904.

N. C. MEDICAL SOCIETY. 871

Joined
Members and Address. Licensed. State

Society.

Person, J. B., Selma 1897 1900

Med. Coll. Va., 1897.

Noble, R. J., Selma 1878 1878

Ky. School Med., 1875.

Noble, Robt. P., Selma 1907 1908

Univ. of N. C, 1907.

Parker, G. E., Benson 1904

P. & S., Balto., 1885.

Booker, E. N., Clayton, R. F. D 1888

Med. Coll. Va., 1887.

McLemore, G. A., Clayton, R. F. D 1906

Univ. N. C, 1906.

Grady, J. C, Kenly 1904

P. & S., Balto., 1886.

Coleman, G. S., Kenly 1907 1908

Med. Coll. Va., 1907.

LENOIR COUNTY SOCIETY.

President, W. T. Parrott, Kinston 1899 1901

Tulane Univ., 1899.

Secretary, C. L. Pridgen, Kinston 1901 1901

Jeff. Med. Coll., 1901.

Woodley, C. B., Kinston 1886 1904

Bellevue Med. Coll., 1886.

Tull, Henry, Kinston 1876 1876

Univ. Pa., 1876.

Parrott, J. M., Kinston 1895 1896

Tulane Univ., 1895.

Parrott, A. DeK., Kinston 1906 1906

Univ. Coll. Med., Va., 1906.

Wliitaker, F. A., Kinston 1907

1 Co. Univ. Pa., 1875.

Wliitaker, R. A., Kinston 1885 1885

P. & S., Balto., 1885.

Hargrove, W. F., Kinston 1901 1901

Univ. Md., 1901.

Wooten, R. W., Kinston 1904

Univ. Va., 1870.

Monk, H. S., Trenton 1896 1904

Med. Coll. Va., 1896.

Hodges, J. M., La Grange 1883 1904

Bellevue Med. Coll., 1883.

Smithwick, J. W. P., La Grange 1894 1898

Univ. Md., 1895.
Denny, W. W., Pink Hill ( honorary ) ....

872 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.
LINCOLN COUNTY SOCIETY.

President, C. H. Hoover, Grouse 1903 1904

Balto. Med. Coll., 1893.

Secretary, R. W. Petrie, Lincolnton 1903 1903

Univ. Md., 1903.

Crowell, L. A., Lincolnton 1892 1898

Balto. Med. Coll., 1892.

Wright, J. B., Lincolnton 1899 1899

Univ. Coll. Med., Va., 1899.

Costner, G. H., Lincolnton 1902 1907

Univ. of Md., 1901.

Saine, Jno. W., Lincolnton 1891 1904

Louisv. Med. Coll., 1891.

Abernathy H. U., Devon 1894 1898

Louisv. Med. Coll., 1894.

Thompson, C. D., Lowesville 1901 1904

Univ. Tenn., 1901.

MACON-CLAY COUNTY SOCIETY.

President, S. H. Lyle, Franklin 1881 1881

Univ. Nashville, 1881.
Secretary, W. A. Rogers, Franklin 1898 1898

Univ. Nashville, 1898.
Siler, F. L., Franklin 1898 1908

Univ. Nashville, 1897.

Jones, H. M., Franklin 1906 1906

Univ. N. C, 1905.

Laphani, Mary E., Highlands 1906 1908

Woman's Med. Coll. of Pa., 1900.

]VL\DISON COUNTY SOCIETY.

President, W. J. Weaver, Marshall 1897 1903

Jeff. Med. Coll., 1898.

Secretary, I. E. Burnett, Mars Hill 1904 1904

Tenn. Med. Coll., 1901.

English, I. L., English 1904

Frisbee, J. T., Lynch 1904

McDevitt, A. J., Walnut 1905 1906

Roberts, Frank, Marshall 1892 1902

Jeff. Med. Coll., 1892.

Robinson, W. F., Mars Hill 1903 1904

Vand. Univ., 1896.

Tilson, J. C, Marshall 1885 1904

1 Co. P. & S., Balto., 1884-5.

Woody, S. B., Spring Creek 1898 1898

Vand. Univ., 1892.

N, C. MEDICAL SOCIETY. 873

Joined
Members and Address. Licensed. State

Society.

Baird, J. H., Mars Hill 1904

Peck, E. J., Hot Springs 1907

Vand. Univ., 1879.

IVIARTIN COUNTY SOCIETY.

President, J. E. Smithwick, Jamesville 1897 1904

Univ. Md., 1897.

Secretary, Wm. E. Warren, Williamston 1893 1904

Non-grad. Univ. N. Y.

Knight, J. B. H., Williamston 1885 1891

P. & S., Balto., 1885.

York, H. B., Williamston 1906 1906

Coll. P. & S., Balto., 1906.

Rhodes, J. S., Williamston 190G 1906

Med. Coll. Va., Richmond, 1906.

Long, B. L., Hamilton 1904

Univ. Md., 1880.

Fleming, M. I., Hamilton 1906 1906

JeflF. Med., Phila., 1906.

Hargrove, W. H., Robersonville 1879 1879

Univ. Md., 1877.

Nelson, R. J., Robersonville 1890 1893

Louisv. Med. Coll., 1890.

Saunders, Jos. H., Everetts 1905 1906

Univ. Coll. Med., Richmond, 1905.

MECKLENBURG COUNTY SOCIETY.

President, C. A., Misenheimer, Charlotte 1882 1882

Univ. N. Y., 1882.

Secretary, Robt. H. Laffertv, Charlotte 1906 1906

N.' C. Med. Coll., 1906.

Alexander, Annie L., Charlotte 1885 1885

Woman's Med. Coll. Pa., 1884.

Alexander, H. Q., Charlotte 1888 1904

Univ. Md., 1888.

Alexander, J. R., Matthews 1894 1898

Univ. Md., 1894.

Austin, J. A., Charlotte 1887 1887

Jeff. Med. Coll., 1887.

Austin, Fred., Charlotte 1907 1908

N. C. Med., 1907.

Crowell, A. J., Charlotte 1892 1894

Univ. Md., 1892,

Costner, T. F., Charlotte 1892

Jeff. Med. Coll., 1882.

Davidson, J. E. S., Charlotte 1898 1898

Univ. of Md., 1894.

^'^4 FIFTY-FIFTH ANNUAL SESSION

Memlers and Address. Licensed. '^State

Society.
Currie, E. W., Charlotte 19q7 jg^g

N. C. Med. Coll., 1907.

Clifford, J. S., Charlotte . I907 1908

Geo. Wash. Univ., Wash., D. C, 1906.

DeArmond, J. M., Mint Hill ' jggg jgg-

Univ. Md., 1880.

Faison, I. W., Charlotte I873 jg^g

Bellevue Med. Coll., 1878.

Gibbon, R. L., Charlotte jggj jggg

Jeff. Med. CoH.i 1892.

Gibbon, J. H., Philadelphia jggi jggg

Jeff. Med. Coll., 1892'.

Graham, W. A., Charlotte jggg jggQ

P. & S., N. Y., 1888.'

Hawley, F. 0., Charlotte 19Q4

Univ. Edinburg, Scot., 1868.

Henderson, S. M., Charlotte I894 J9Q4

Univ. Md., 1894.

Hovis, L., Charlotte I904 iqqq

N. C. Med. Coll., i904.

Hunter, L. W., Charlotte 18g0 jgso

Bellevue Med. Coll., 1875.

Irwin, J. P., Charlotte Ig82 igg2

Univ. of Md., 1879.

Keerans, L. C, Charlotte 1906 1906

Univ. Md., 1902.

Knox, Jno., Randalburg 1904

King, P. M., Charlotte I902 1904

Univ. and Bellevue, N. Y., 1902.

Long, V. M., Nevvells 1906 19O8

N. C. Med. Coll., 1906.

McLaughlin, C. S., Charlotte I903 1903

Univ., 1896.

Montgomery, J. C, Charlotte Iggi iggi

Univ. N. Y., 1891.

Munroe, J. P., Charlotte Igg6 iggo

Univ. Va.. 1885.

Moore, B. S., Charlotte I905 190.5

Univ. Va., 1905.

Nisbet, W. O., Charlotte 1889 1899

Med. Coll. S. C., 1889.

Pharr, W. W., Charlotte 1885 1885

P. & S., Balto., 1881.

Pressly, G. W., Charlotte 1895 iggg

Jeff. Med. Coll., 1892.

Peeler, C. K, Charlotte 1906 1907

N. C. Med. Coll., 1906.

Reid, W. R., Pineville I891 i896

Univ. of N. Y., 1891.

N. C. MEDICAL SOCIETY. 875

Joined
Members and Address. Licensed. State

Society.

Russell, E. R., Charlotte 1895 1898

Univ. Md., 1895.

Univ. N. Y., 1885.

Simmonds, J. O., Charlotte 1906 1906

Grant Univ., 1904.

Walker, E. C, Charlotte 1891 1894

Univ. Md., 1891.

Wakefield, W. H., Charlotte 1891 1893

Hosp. Coll. Med., Ky., 1890.

Winchester, F. M., Charlotte 1887 1904

Jeff. Med. Coll., 1883.

Whistnant, A. M., Charlotte 1893 1894

P. & S., Balto., 1893.

Witherbee, W. D., Charlotte 1905 1905

McGill Univ., 1899.

Allen, Wm., Charlotte 1906 1908

Coll. P. & S. Balto., 1906.

Wooten, W. H., Davidson 1894 1908

N. C. Med. Coll., 1894.

Wakefield, H. W., Charlotte. 1908 1908

N. C. Med. Coll., 1908.

MITCHELL COUNTY SOCIETY.

President, V. R. Butt, Bakersville 1907

Jeff. Med. Coll., 1871.

Secretary, Chas. G. Bryant, Spruce Pine 1902 1907

Louisv. Med. Coll., 1894.

Peterson, C. A., Spruce Pine 1907 1908

N. C. Med. Coll., 1907.

Slagel, F. P., Bakersville 1908

Sloop, E. H., Plum Tree 1905 1907

N. C. Med. Coll., 1905.

MOORE-LEE COUNTY SOCIETY.

President, John P. Monroe, Sanford 1901 1903

P. & S., Balto., 1901.

Secretary, Gilbert McLeod, Carthage 1885 1904

Univ. Md., 1882.

Blair, A. McNeill, Southern Pines 1904 1906

Niagara Univ., 1897.

Caviness, A. H., High Falls 1903

Univ. Balto., 1901.

Gladmon, Edwin, Southern Pines 1899 1902

Nat. Univ., Wash., 1890.

Gilmore, W. D., Sanford 1903 1904

Univ. N. C, 1903.

876 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Addr-ess. Licensed. Utate

Society.

Hoyle, H. B., Jonesboro 1896 1904

N. C. Med. Coll., 1896.

Laster, P. D., Monciire 1906

Louis. Md. Coll., 1875.

McDonald, A. A., Jackson Springs 1907 1908

N. C. Med. Coll., 1905.

Melver, Lynn, Sanford 1902 1903

Univ. Ky., 1901.

McLeod, A. H., Aberdeen 1896 1904

Balto. Med. Coll., 1896.

Matthews, J. H., Carthage 1907 1908

N. C. Med. Coll., 1907.

Matthews, M. L., Cameron 1903 1904

N. C. Med. Coll., 1903.

Monroe, W. A., Sanford 1886 1888

Univ. Md., 1886.

Mudgett, W. C, Southern Pines 1908 1908

Md. Med. Coll., 1903.

Palmer, Robt. VV., Gulf 1891 1891

Louisv. Med. Coll., 1890.

Sheppard, J. L., Sanford, R. F. D

Shields, H. B., Carthage 1887 1904

Atlanta Med. Coll., 1887.

Snipes, E. P., Jonesboro 1890 1890

Vanderbilt Univ., 1890.

Street, M. E., Glendon 1883 1902

P. & S., Balto., 1890.

Swett, Wm. P., Southern Pines 1901 1901

Univ. Vt., 1896.

Watson, Leon; Broadway 1900 1904

N. C. Med. Coll., 1900.

Willcox, J. W., Carthage 1906 1906

Univ. N. C, 1906.

MONTGOMERY COUNTY SOCIETY.

President, A. F. Thompson, Troy 1895 1904

Med. Coll., Ind., 1895.

Secretary, C. Daligny, Troy 1906

Military Med. S., Paris, 1878.

Bowman, H. E., Biscoe 1905 1906

N. C, 1904.

Gilmore, W. D., Mt. Gilead 1903 1908

Univ. of N. C, 1903.

Grantham, W. L., Mt. Gilead 1906 1908

N. C. Med. Coll., 1906.

Ingram, C. B., Mt. Gilead 1886 1902

Jeff. Med. Coll., Pa., 1886.

N. C. MEDICAL SOCIETY. 877

Joined
Members and Address. Licensed. State

Society.

Shamberger, J. B., Star 1890 1892

Univ. of Md., 1890.

Asbury, F. E., Asbury 1896

S. C. Coll. Med., 1876.

Mcdowell county society.

President, B. A. Cheek, Marion 1904

Univ. Pa., 1860.

Secretary, D. M. Mcintosh, Old Fort 1907 1908

Med. Coll. Va., 1904.

Justice, M. L., Marion 1897 1904

Xongrad. N. C. Med. Coll.

Morphew, M. F., Marion 1893

P. & S., Balto., 1883.

Justice, G. B., Marion 1907 1908

P. & S., Atlanta, 1907.

Kirby, G. S., Marion 1897 1903

Univ. Coll. Med., Va., 1897.

Gilbert, W. W., Dysartsville 1904

Chaney, T. M., Old Fort 1908 1908

Md. Univ., 1906.

Ashworth, B. L., Marion 1893 1895

P. & S., Balto., 1892.

NASH COUNTY SOCIETY.

President, Jas. P. Battle, Nashville 1889 1904

Univ. Md., 1888.

Secretary, J. P. Whitehead, Rocky Mount 1899 1899

Univ. Md., 1899.

Brantley, C. H., Finch 1894 1904

P. & S., Balto., 1887.
Brantley, Hassell, Spring Hope 1888 1901

Univ. Md., 1888.

Covington, L. C, Rocky Mount 1902 1902

Univ. Coll. Med., Va., 1901.
Dew, S. P., Spring Hope 1885 1906

Univ. Md., 1885.
Marriott, H. B., Battleboro 1883 1904

Univ. Md., 1883.
Matthews, T. A., Castalia 1891 1895

Univ. Md., 1891.

Miller, Robt. B., Rocky Mount 1900 1902

Med. Coll. Va., 1898.

Phillips, Jas. B., Jr., Selma 1904 1904

Univ. Md., 1903.
Speight, R. H., Jr., Rocky Mount 1901 1901

Univ. Md., 1901.

878 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Strickland, J. T., Nashville 1890 1904

Univ. Md., 1890.

Wliitehead, W. H., Rocky Mount 1875 1875

Univ. Md., 1870.

Whittaker, W. H., Hilliardston 1883 1905

Miss. Med., 1883.

NEW HANOVER COUNTY SOCIETY.

President, E. J. Wood, Wilmington 1903 1903

Univ. Pa., 1902.

Secretary, T. M. Green, Wilmington 1901 1904

Univ. Md., 1901.

Nesbit, Chas. T., Wilmington 1907 1908

Balto. Med. Coll., 1903.

Harper, Chas. T., Wilmington 1893 1904

Univ. Md., 1904.

Hall, Wright, Wilmington 1904

Non-grad. P. & S., Balto.

Bullock, D. W., Wilmington 1875 1875

Univ. Med., 1873.

Wessell, J. C, Wilmington 1900 1900

Univ. Mea., 1900.

Borneman, J. H., Wilmington 1904 1908.

Jeff. Med. Coll., 1903.

Schonwald, J. T., Wilmington 1880 1904

Long Island Med., 1879.

Bellamy, R. H., Wilmington 1902 1902

Jeff". Med. Coll., 1902.

Harnett, Harry, Wilmington 1901 1904

P. & S., N. Y., 1900.

Akerman, J., Wilmington 1905 1906

Johns Hopkins, 1905.

Cranmer, J. B., Wilmington 1905 1906

Univ. N. C, 1905.

Caldwell, M. M., Wilmington 1906 1907

Jeff Med. Coll., 1901.

MacMillan, W. D., Wilmington 1904

Univ. Md., 1868.

Murphy, J. G., Wilmington 1903 1905

Univ. of Louisville, 1903.

Harris, A. H., Wilmington 1892 1904

Medico Chi. Coll., Pa., 1893.

Slocum, R. B., Wilmington 1907 1908

Johns Hopkins, 1905.

McDonald, A. D. (honorary) 1877 1877

Wash. Univ. of Med., 1877.

Thomas, P. J., Wilmington 1902 1902

Univ. Md., 1902.

N. C. MEDICAL SOCIETY. 879

Joined
Members and Address. Licensed. State

Society.

Thomas, Geo. G., Wilmington 1871 1871

Univ. Md., 1871.

Bell, C. D., Wilmington 1904

Univ. Md., 1883.

Russell, F. H., Wilmington 1893 1895

Univ. Md., 1893.

Love, W. J. (honorary member) 1861 1870

S. C. Med. Coll., 1861.

Bellamy, W. J. H., Wilmington 1870

Univ. N. Y., 1868.

NORTHAMPTON COUNTY SOCIETY.

President, A. J. Ellis, Garysburg 1904

Univ. of Pa., 1858.

Secretary, R. P. Morehead, Lasker 1895 1900

P. & S. Balto., 1895.

Mahlon, Balton, Rich Square 1885 1885

Jeff. Med. Coll., 1885.

Joyner, R. H., Woodland 1904

Lewis, H. W., Jackson 1887

Univ. of N. Y., 1877.

Stancell, R. H., Margarettsville 1887

Med. Coll. Va., 1865.

Cook, Q. H., Woodland 1905 1906

Univ. of N. C, 1905.

Reed, D .H., Conway 1904 1906

Columbian Univ., 1901.

Joyner, T. 0., Severn 1899 1904

Univ. Coll. Med., 1899.

ORANGE COUNTY SOCIETY.

President, I. H. Manning, Chapel Hill 1899 1901

Long Island Med. Coll., 1887.

Secretary, C. D. Jones, Hillsboro 1891 1901

Vanderbilt Univ., 1887.

Abernathy, E. A., Chapel Hill 1901 1905

Univ. Coll. Med., Va., 1901.

Hester, J. R., Prospect Hill 1894

Univ. Tenn.

Hughes, C. M., Cedar Grove 1901 1904

Atlanta Med. Coll., 1897.

Mangum, C. S., Chapel Hill 1896 1898

Jeff. Med. Coll., 1894.

Murphy, W. E., Carr 1904

Louisv. Med. Coll., 1876.

MacNider, Wm. DeB., Chapel Hill 1903 1903

Univ. of N. C, 1903.

Whitehead, R. H., Charlottesville. Va 1889 1891

Univ. Va., 1888.

880 FIFTY-FIFTH ANNUAL, SESSION

Joined
Members and Address. Licensed. State

Society.
ONSLOW COUNTY SOCIETY.

President, E. L. Cox, Jacksonville 1889 1892

Univ. Med., 1889.
Secretary, C. Thompson, Jacksonville 1904

Tulane Univ., 1878.
Sutton, C. W., Richlands 1905 1906

Tulane Univ., 1905.

Nicholson, J. L., Richlands 1880 1880

Univ. N. Y., 1875.
PAMLICO COUNTY SOCIETY.

President, G. S. Atmore, Sonewall 1870 1904

Wash. Univ., 1870.

Secretary, C. A. Flowers, Bayboro 1907 1908

P. & S., Balto., 1905.

Daniels, O. C, Oriental 1903 1904

Med. Coll. Va., 1903.

Dees, D. A., Bayboro 1903 1905

Balto. Med. Coll., 1903.

PENDER COUNTY SOCIETY.

President, W. H. Crowell, Burgaw 1895 1896

Univ. Md., 1895.
Secretary, R. H. Bradford, Burgaw 1904 1905

N. C. Med. Coll., 1904.

Alexander, L. L., Topsail Sound 1904

Univ. N. Y., 1869.

Lucas, Geo. F., Currie 1904

Univ. N. Y., 1870.

Williams, R. J., Rocky Point 1893 1904

JeflF. Med. Coll., 1893.

PERSON COUNTY SOCIETY.

President, C. G. Nichols, Roxboro 1885 1891

Non-grad. Bellevue.

Secretary, W. A. Bradsher, Roxboro 1904 1905

Univ. Md., 1904.

Baynes, R. S., Hurdle Mills, R. F. D. No. 2 1881 1904

P. & S., Balto., 1881.

Long, W. T., Roxboro 1905 1907

Balto. Med. Coll., 1905.

Love, B. E., Roxboro 1904 1905

Univ. Md., 1904.

Merritt, J. H., Woodsdale, R. F. D., No. 2 1907 1908

Univ. N. C, 1906.

Sehaub, O. P., Roxboro 1898 1898

Balto. Med. Coll., 1898.

Swann, J. F., Semora 1898 1904

P. & S., Balto., 1898.

N. C. MEDICAL SOCIETY. 881

Joined
Members and Address. Licensed. State

Society.
PASQUOTANK-CAMDEN-DARE COUNTY SOCIET\'.

President, John B. Griggs, Elizabeth City 1892 1904

Univ. Md., 1892.

Secretary, Zenos Fearing, Elizabeth City 1901 1904

Univ. Med. Coll., Va.
Lumsden, W. J., Elizabeth City 1888

Univ. Md., 1869.
McMuUan, 0., Elizabeth City 1889

Univ. Va., 1880.

Wood, J. E., Elizabeth City 1904

Wash. Univ., Md., 1869.
Sawyer, C. W., Elizabeth City 1904

Univ. Md., 1886.

Fearing, I., Elizabeth City 1896 1904

P. & S., Balto., 1896.
Aydlette, H. T., Elizabeth City 1895 1896

Univ. Va., 1894.

Williams, C. B., Elizabeth City 1903 1906

Univ. Coll. Med., Va., 1903.
Walker, H. D., Elizabeth City 1902 1902

Univ. Md., 1902.

Ferebee, C. G., Shiloh 1904 1904

Med. Coll. Va., 1903.
Fearing, W. B., Manteo 1904

Univ. Md., 1881.
Davis, J. J., Buxton 1891 1905

Univ. Md., 1891.
Sawyer, W. W., Shiloh 1903 1905

Univ. Md., 1903.

Lister, J. L., South Mills 1896 1907

Med. Coll. of Va., 1896.

PERQUIMANS COUNTY SOCIETY.

President, Wm. Riddick, Hertford 1904

Univ. Pa., 1854.
Secretary, R. W. Smith, Hertford 1892 1904

Univ. Md., 1902.

White, Thos. N„ Belvidere 1875 1905

P. & S., Balto.
McMullan, Thomas S., Hertford 1889 1892

Univ. Va., 1888.

PITT COUNTY SOCIETY.

President, W. C. Whitfield, Grifton 1884 1884

Univ. Md., 1884.

882 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Secretary, J. E. Nobles, Greenville 1899 1902

Jeff. Med. Coll., 1899.

Hudson, J. H., Greenville, R. F. D 1907 1908

Balto. Med. Coll., 1907.

Frizzelle, M. T., Ayden 1907 1908

Univ. Coll. Med., 1907.

Patrick, J. E., Farmville 1900 1900

Univ. Coll. Med., 1900.
Moye, E. A., Greenville 1895 1897

Jeff. Med. Coll., 1895.
Joyner, C. C, Farmville 1899 1904

Jeff. Med. Coll., 189d.

Basnight, T. G., Stokes 1905 1906

Univ. Md., 1904.

Brown, Zeno, Greenville 1885 1885

Bellevue Med. Coll., 1883.

Cox, B. T., Winterville 1888 1888

Univ. Md., 1888.

Dawson, W. W., Grifton 1897 1900

Univ. Md., 1897.

Dixon, Jos., Ayden 1893 1895

Med. Coll. Va., 1894.

Fountain, Wm., Greenville 1899 1899

Univ. Coll. Med., Va., 1898.

Grimes, R. J., Bethel 1876 1904

Univ. Pa., 1876.

James, F. C, Bethel 1894

Columbian Univ., D. C, 1859.

Jones, C. M., Grimesland 1892 1895

Univ. Md., 1892.

Laughinghouse, Chas. O'H., Greenville 1893 1894

Univ. Pa., 1893.

Morrill, D. S., Farmville 1897 1904

Balto. Med. Coll., 1897.

Morrill, Jenness, Falkland 1888 1904

Univ. Md., 1888.

Ricks, L. E., Shelmerdine 1896 1898

Med. Coll. Va., 1896.

Skinner, L. C, Ayden 1901 1902

Univ. Md., 1901.

Thigpen, G. F., Bethel 1903 1904

Univ. Md., 1903.

RANDOLPH COUNTY SOCIETY.

President, S. A. Henley, Asheboro 1888

Attended Jeff. Med. Coll. 1861.

Secretary, C. C. Hubbard, Farmer 1890 1904

Jeff. Med. Coll., 1888.

N. C. MEDICAL SOCIETY. 883

Joined
Members and Address. Licensed. State

Society.

Sumner, W. I., Randleman 1894 1894

Univ. Tenn., 1893.

Moore, W. J., Asheboro 1893 1901

P. & S., Balto., 1892.

McFadyen, P. E., Randleman 1901 1904

Med. Coll. of Va., 1901.

Fox, T. I., Franklinsville 1899 1904

Vanderbilt, 1894.

Hunter, J. V., Asheboro 1898 1904

Univ. Louisville, Ky., 1898.

Foust, D. Leroy, Liberty 1905 1908

N. C. Med. Coll., 1905.

Welborn, W. P., Coleridge 1908 1908

N. C. Med. Coll., 1905.

RICHMOND COUNTY SOCIETY.

President, A. C. Everett, Rockingham, R. F. D 1897 1903

Univ. Md., 1897.

Secretary, J. I. Fowlkes, Hamlet 1903 1903

Atlanta Coll. P. &. S., 1903. ■

Kinsman, H. F., Hamlet 1897 1904

Univ. Vt., 1894.

Ledbetter, J. M., Rockingham 1894 1903

Vanderbilt, 1894.
Garrett, F. J., Rockingham 1897 1904

Univ. Md., 1889.

Hunter, N. C, Rockingham 1899 1904

Medico-Chir., Phila., 1899.

McPhail, L. D., Rockingham 1900 1902

Univ. Md., 1900.

Steele, W. H., Rockingham 1874 1904

Bellevue Med. Coll., 1874.

Webb, W. P., Rockingham 1897 1904

Med. Coll. S. C, 1897.

Williamson, J. H., Rockingham, R. F. D 1904

Bellevue Med. Coll., 1859.

ROBESON COUNTY SOCIETY.

President, B. F. McMillan, Red Springs 1684 188*

Univ. Md., 1882.
Secretary, A. B. Croom, Maxton 1905 1906

Univ. Md., 1905.
Brown, J. P., Fairmont 1904

Univ. Md., 1883.

Croom, J. D., Maxton 1887

Med. Coll of S. C, 187G.

Currie, D. S., Parkton 1906 1906

N. C. Med. Coll., 1906.

884 FIFTY-FIFTH ANNUAL SESSION

Joijied
Members and Address. Licensed. State

Society.

Dickson, A. P., Raeford 1906

Univ. N. Y., 1878.

Evans, W. E., Rowland 1894 1904

Med. Coll. Va., 1894.

Gibson, M. E., Maxton 1905 1908

Univ. Md., 1905.

Hodgin, H. H., Red Springs 190G 1906

N. C. Med. Coll., 1906.

Kirkpatrick, L. R., Maxton 1902 1902

N. C. Med. Coll., 1902.

Knox, John, Jr., Lumberton 1907 1907

Univ. Md., 1906.

McKenzie, J. C, Orrum 1907

McKinnon,, W. H., Red Springs 1905

Bellevue Med. Coll., 1870.

McMillan, J. L., Red Springs 1881 1902

Univ. Md., 1881.

McNatt, H. W., Maxton 1905

Univ. Md., 1881.

McPhaul, W. A., Lumberton 1905 1906

Univ. Nashville, 1905.

Norment, R. M., Lumberton 1893 1904

Univ. Md., 1893.

Norment, T. A., Lumberton 1893 1908

N. C. Med. Coll. 1894.

Northrup, T. L., St. Paul's 1897 1903

Univ. Md., 1897.

Pate, G. M., Rowland 1900 1905

Med. Coll. S. C, 1900.

Pope, H. T., Lumberton 1893 1902

N. C. Med. Coll., 1894.

Reedy, Howard, Rowland 1904

Med. Coll. S. C, 1884.

Rozier, B. S., Lumberton 1904

Med. Coll. Va., 1855.

Rozier, R. G., Lumberton 1899 1904

Univ. Md., 1899.

Stamps, Thomas, Lumber Bridge 1888 1888

Univ. Louisville, 1888.

Stevens, W. F., Fairmont 1898 1904

Tenn. Med. Coll., 1901.

Thompson, N. A., Lumberton 1895 1904

Md. Med. Coll., 1895.

Kitchin, Thurman D., Lumberton 1908 1908

Md. Med. Coll., 1908.

McMurray, H. E., Fairmont 1908 1908

Md. Med. Coll., 1902.

N. C. MEDICAL SOCIETY. 885

Joined
Members and Address. Licensed. State

Society.
ROCKINGHAM COUNTY SOCIETY.

President, John Sweeney, Leaksville 1904

P. & S., Balto., 18S6.

Secretary, J. W. McGehee, Reidsville 1904 1905

Univ. Md., 1904.

Mills, J. C, Reidsville 1907

Univ. Penn., 18G9.

Ray, J. B., Leaksville 1890 1904

B. M. C, 1890.

Tuttle, A. F., Leaksville 1901 1906

N. C. Med. Coll., 1901.

\Vliarton, C. R., Ruffin 1897 1904

Med. Coll. Va., 1897.

ROWAN COUNTY SOCIETY.

President, Henry L. Monk, Spencer 1899 1903

Med. Coll. Va., 1897.

Secretary, Julius A. Caldwell, Salisbury 1905 1905

Johns Hopkins, 1904.

Atkins, Geo. J., China Grove 1894 1905

P. & S., Balto., 1894.

Cowan, Robt. Locke, Salisbury ....

Gaither, John Burgess, China Grove 1904

P. & S., Balto., 1869.

Ramseur, Geo. Alex, China Grove 1898

Jeff. Med. Coll., 1880.

Summerell, Mitchell E., China Grove, R. F. D 1883 1883

Univ. Pa., 1883.

Chenault, Wm. F., Cleveland 1888 1891

Univ. Md., 1888.

Poole, Chalmers M., Craven 1880 1880

P. & S., Balto., 1880.

Goodman, A. B., Crescent 1897 1904

N. C. Med. Coll., 1898.

Withers, Banks, Enochsville 1906

P. & S., N. Y., 1905.

Fitzgerald, J. Y., Gold Hill 1889 1906

Jeff. Med. Coll., 1889.

Peeler, John H., Granite Quarry 1899 1904

Univ. Coll. Med., Va., 1899.

Brown, Geo. A., Mt. Ulla 1897 1898

Univ. Coll. Med., Va., 1897.

Brawlev, Robt. V., Salisbury 1900 1904

Univ. Coll. Med., Va., 1900.

Councill, Jeff B., Salisbury 1885 1904

P. & S., Balto., 1885.

Crump, Wm. L., Salisbury 1881 1904

Jeff. Med. Coll., 1879.

886 FIFTY-FIFTH ANNUAL, SESSION

Joined
Memhcrs and Address. Licensed. State

Society.

Dorsett, E. Rose, Salisbury 1004

Jeff. Med. Coll., 1869.

Foust, Isaac H., Salisbury 1898 1904

Vanderbilt Univ., 1899.

Heilig, Vernon G., Salisbury 1899 1904

Univ. Md., 1899.

McKenzie, Wm. W., Salisbury 1893 1894

Jeff. Med. Coll., 1893.

Sawyer, Chas. J., Salisbury 1895 1897

_P. & S., Balto., 1895.

Stokes, J. Ernest, Salisbury 1900 1901

Univ. Md., 1892.

Trantham, Henry T., Salisbury 1878 1879

Univ. N. Y., 1875.

West, Robt. M., Salisbury 1900 1904

'Med. Coll. Va., 1900.

Whitehead. John, Salisbury 1880 1880

Univ. Pa., 1880.

Busby, Julian G., Spencer 1904 1905

Univ. Md., 1904.

Snioot, Marvin L., Spencer 1903 1904

Univ. Coll. Med., Va., 1903.

Young, Jas. W., Spencer 1898 1908

Univ. Md., 1898.

Holshauser, A. L., Rockwell ....

Bowers, A. H., Gold Hill

Univ. Coll. Med., 190G.

Woodson, C. W., Salisbury 1905 1907

Coll. P. & S., N. Y., Columbia Univ., 1904.

Flippin, J. M., Salisbury 1893

P. & S., Balto., 1884.

RUTHERFORD COUNTY SOCIETY.

President, Oliver Hicks, Caroleen 1904

Med. Coll. Pa.

Secretary, E. B. Harris, Rutherfordton 1904

P. & S., Balto.

Andrews, R. M., Cliffdale 1904 1905

Mem. Hosp. Coll., 1904.

Biggs, H. M., Rutherfordton 1907 1908

Univ. of Pa., 1897.

Chapman, G. M., Logan's Store 1904 1905

Grant Univ., 1904.

Bostic, W. C, Forest City 1905 1900

K C. Med. Coll., 1905.

Hamriok, T. G., Caroleen 1895 1904

P. & S., Balto., 1895.

N. C. MEDICAL SOCIETY. 887

Joined
Members and Address. Licensed. State

Society.

Hicks, Eomeo, Henrietta 1899

So. Med. Coll., Ga., 1888.

Harrill, L. B., Caroleen 1904

Grant Univ., Tenn.

Lovelace, T. B., Henrietta 1904

P. & S., Balto., 1883.

Reid G. P., Forest City 1894 1899

tlniv. Coll. Med., Va., 1895.

Twitty, T. B., Pvutherfordton 1904

Univ. N. Y., 18G3, 1 year.

Twitty, J. C, Rutherfordton 1892 1906

Balto. Med., 1892.

Thompson, J. B., Cliffdale 1898 1904

P. & S. Balto., 1898.

Thompson, W. A., Rutherfordton 1904

P. & S., Balto.

Wiseman, C. B., Henrietta 1902 1902

P. & S., Balto., 1902.

Young, G. E., Forest City 1885 1904

Non-grad. Univ. Penn., lisoO.

Hayn^s, B. M., Cliffside 1905 1906

N. C. Med. Coll., 1905.

Norris, Henry, Rutherfordton 1906 1908

Univ. Pa., 1006.

SAMPSON COUNTY SOCIETY.

President, F. H. Holmes, Clinton 1895 1896

Univ. Md., 1895.

Secretary, G. M. Cooper, Clinton 1905 1906

Univ. Coll. Med., Va., 1905.

Stevens, J. A., Clinton 1883 1883

Jeff. Med. Coll., 1883.

Hiatt, H. B., Clinton 1907 1908

Univ. Md., 1907.

Lee, A. M., Clinton 1904

Med. Coll. Va., 1862.

Matthews, J. 0., Clinton, R. F. D 1897 1902

Univ. Coll. Med., Va., 1897.

Kerr, C. S., Kerr's 1904

Univ. Md., 1869.

Taylor, W. I., Kerr's, R. F. D 1904 1905

N. C. Med. Coll., 1902.

Sloan, Henry, Ingold 1885 1902

S. C. Med. Coll., 1881.

Grumpier, Paul, Roseboro 1907 1908

Univ. Tenn., 1907.

Sikes, G. L., Salemhurg 1900 1904

Univ. Coll. Med., Va., 1900.

888 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Wilson, R. B., Newton Grove 1890 1904

Ky. Seh. Med., 1889.

McLean, R. H., Dunn, R. F. D. No. 6 1907

P. & S., Balto., 1882.

SCOTLAND COUNTY SOCIETY.

President, W. T. Pate, Gibson 1885 1885

P. & S., Balto., 1885.

Secretary, A. W. Hamer, Laurinburg 1886 1904

S. C. Med. Coll., 1858.

Prince, D. M., Laurinburg 1878 1879

S. C. Med. Coll., 1875.

Blue, K. A., Laurinburg 1890 1892

Univ. Md., 1889.

Shaw, VV. G., Fontcol 1895 1904

P. & S., Balto., 1892.

John, Peter, Laurinburg 1897 1904

Univ. Md., 1897.

Everington, G. D., Laurinburg 1898 1898

N. C. Med. Coll., 1899.

McLean, N. M., Gibson 1883 1888

Univ. Md., 1883.

Gibson, J. S., Gibson 1906 1906

Univ. Md., 1906.

McLean, Peter, Laurinburg 1907 1908

Univ. Md., 1907.

Jones, Win. D., Laurinburg 1908 1908

Univ. Md., 1908.

STANLY COUNTY SOCIETY.

President, 0. D. King, Albemarle 1884

Long I. Hosp. Med. Coll., 1884.

Secretary, W. I. Hill, Albemarle 1897 1904

Univ. Md., 1897.

Anderson, J. N., Albemarle 1895 1904

Univ. Md., 1895.

Whitley, V. A., Albemarle 1884 1904

Univ. Md., 1884.

Hartsell, F. E., Big Lick 1895 1905

Balto. Med. Coll., 1895.

Hathcock, T. A., Norwood 1893 1904

Univ. Md., 1893.

Allen, J. A., New London 1901 1906

Univ. Coll. Med., 1901.

Whitley, D. P., Millingport 1890 1898

Univ. Md., 1889.

Campbell, J. I., Whitney 1898 1904

Undergraduate N. C. Med. Coll.

N. C. MEDICAL SOCIETY.

889

Joined
Members and Address. Licensed. State

Society.

Hall, J. Clegg, Albemarle 1899 1904

Univ. Coll. Med., 1899.

Cox, B. F., Palmerville 1886 1907

Coll. P. & S., Balto., 188G.

STOKES COUNTY SOCIETY.

President, L. H. Hill, Geiraanton 1877 1877

Jeff. Med. Coll., 1877.

Secretary, E. Fulp, Fulp 1896

Univ. N. Y., 1882.

Phillips, M. D., Dalton 1881 1904

Univ. N. Y., 1881.

Moore, W. B., Smith 1893 1904

P. & S., Balto., 1893.

Moir, S. A., Francisco 1904

P. & S., Balto., 1888.

Leak, J. J., Dan River 1904

Univ. Coll. Med. Va., 1901.

Smith, J. T., Westfield 1899 1904

Jeff. Med. Coll., 1899.

Neal, J. W., Meadows 1904

P. & S., Balto., 1889.

Jones, A. J., Walnut Cove 1894 1904

Univ. X. Y., 1868.

SURRY COUNTY SOCIETY.

President, J. B. Smith, Pilot Mountain 1896

P. & S., Balto., 1885.
Secretary, E. M. Hollingsworth, Mt. Airy 1886 1904

P. & S., Balto., 1886.
Allred, E. W., Mt. Airy 1904

Jeff. Med. Coll., 1877.
Ashby, T. B., Mt. Airy 1885 1896

P. & S., Balto., 1885.
Hollingsworth, J. M., Mt. Airv 1886 1904

P. &'S., Balto., 1886.

Hollingsworth, R. E., Mt. Airy 1899 1904

Univ. Coll. Va., 1898.

Taylor, W. S., Mt. Airy 1894

JetL Med. Coll., 1874.

Mebane, W. C, Mt. Airy 1905 1908

N. C. Med., 1905.

Flippin, R. E. L., Pilot Mountain 1897 1901

Balto. Med. Coll., 1897.

Woltz, J. L., Pilot Mountain 1902 1904

So. Med. Coll., Ga., 1897.

Flippin, S. T., Siloam 1898 1898

N. C. Med. Coll., 1898.

890 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.

Ring, J. W., Elkin 1904

P. & S., Balto., 1880.

Reece, J. M., Elkin 1904

P. & S,, Balto., 1886.

Woltz, J. R., Dobson 1904

Stone, Wm. M., Dobson 1906 1907

N. C. Med. Coll., 1906.

Thompson, K., Kapp's Mill 1904

Jeff. Med. Coll., 1858.

Lawrence, C. L., Mt. Airy 1908 1908

Geo. Wash. Univ., 1908.

SWAIN COUNTY SOCIETY.

President, R. L. Davis, Bryson City 1903

So. Med. Coll., Ga., 1891.

Secretary, A. M. Barnett, Bryson City 1885 1899

Non-grad. Louisv. Med. Coll., 1884.

Bryson, D. R., Bryson City 1900 1904

Univ. Md., 1900.

League, J. H., Whittier 1885 1904

Nongrad. Jeff. Med. Coll., 1881.

Cooper, J. A., Almond 1904

Holt, R. D., Cherokee 1899 1904

Med. Coll. Va., 1899.

TRANSYLVANIA COUNTY SOCIETY.

President, E. S. English, Brevard 1902 1904

Univ. of South, 1901.

Secretary, Goode Cheatham, Brevard 1895 1S9G

N. C. Med. Coll., 1895.

Wallis, W. J., Brevard 1897 1904

P. & S., Balto., 1892.

Lyday, W. M., Penrose 1904

P. & S., Balto., Md., 1891.

Hunt, C. W., Brevard 1881 1904

P. & S., Balto., 1880.

Lyday, A. E., Penrose 1904

Tenn. Med. Coll.

King, M. M., Brevard 1904

Eclectic Med. Coll., Ga., 1880.

UNION COUNTY SOCIETY.

President, H. C. Housten, Waxhaw 1899 1903

Univ. Nashville, 1899.

Secretary, John W. Neal, Monroe 1887 1904

Univ. N. Y., 1884.

N. C. MEDICAL SOCIETY. 891

Joined
Members and Address. Licensed. State

Society.

Armfield, R., Marshville 1904

Med. Coll. Va., 1881.

Blair, J. M., Monroe 1898

Louisv. Med. Coll., 1887.

Dees, W. A., Marshville 1893 1904

Univ. Ga., 1891.
Eubanks, J. B., Monroe, E. F. D 1904

Vanderbilt Univ., 1887.
Nance, G. B., Monroe 1885 190-1

Jeff. Med. Coll., 1885.

Price, W. H., Matthews 1904

Stevens, S. A., Monroe 1898 1904

Univ. Md., 1900.

Stewart, H. D., Monroe 1898 1904

Univ. Md., 1898.

Whitley, A. D. N., Unionville 1897 1904

Nongrad. Univ. Md.

McCain, W. R., Waxhaw 1898 190G

Univ. Md., 1897.

Ashcraft, J. E., Monroe 1887 1888

Univ. N. Y., 1887.

Blair, M. P., Marshville 1904

Med. Coll. Va., 1895.

Perkins, D. R., Marshville 1906 1906

Balto. Med. Coll., 1903.

Jerome, J. R., Wingate 1904

Univ. Md., 1890.

VANCE COUNTY SOCIETY.

President, H. H. Bass, Henderson 1899 1900

Univ. Coll. Med., Va., 1899.
Secretary, Edwin F. Fenner, Henderson 1906 1907

Univ. Md., 1905.
Tucker, John Hill, Henderson ' 1899 1904

Univ. Va., 1899.

Harris, F. R., Henderson 1882 1883

Univ. Va., 1881.

Pendleton, A. S., Henderson 1898 1899

Univ. Pa., 1895.

Gill, R. J., Henderson 1868 1883

Univ. Pa., 1867.

McAllister, Wm., Middleburg 1890 1904

P. & S., Balto., 1890.

Alston, B. P., Epsom 1868

Univ. Md., 1868.

Carstarphen, W. T., Kittrell 1906 1908

Jeff. Med. Coll., 1906.

892 FIFTY-FIFTH ANNUAL SESSION

Joined
Members and Address. Licensed. State

Society.
WAKE COUNTY SOCIETY.

President, W. I. Royster, Raleigh 1869 1871

Bellevue Med. Coll., 1869.

Secretary, W. C. Horton, Raleigh 1896 1904

P. & S., Balto., 1897.

Abernethy, C. O., Raleigh 1906 1906

Univ. N. C, 1906.

Anderson, Albert, Raleigh 1888 1889

Univ. Va., 1888.

Barefoot, J. J., Raleigh 1907 1908

Univ. N. C, 1907.

Battle, K. P., Jr., Raleigh 1882 1882

Univ. Va., 1881; Bellevue, 1882.

Bell, G. M., Wakefield 1903

P. & S., Balto., 1880.
Blalock, N. M., Gulley's Mills 1890 1904

P. & S., Balto., 1890.

Boone, W. H., Morrisville 1902 1904

N. C. Med. Coll., 1902.
Bufl'aln, J. S., Garner 1900 1904

Balto. Med. Coll., 1900.

Burt, B. W., Enno 1886 1904

P. & S., Balto., 1886.

Caveness, Z. M., Zebulon 1903 1903

Univ. N. C, 1903.

Cotton, A. T., Raleigh 1885

P. & S., Balto., 1879.

Dixon-Carroll, E. Delia, Raleigh 1900 1900

Woman's Med., N. Y., 1895.

Ferebee, E. B., Raleigh 1885 1903

P. & S., Balto., 1885.

Fowler, M. L., Rolesville 1904

P. & S., Balto., 1881.
Gaines, Lewis M., Wake Forest 1906 1906

Johns Hopkins, 1903.

Goodwin. A. W., Raleigh 1887 1887

Bellevue Med. Coll., 1887.

Harris, H. H., Wake Forest 1860 1886

Univ. Pa., 1800.

Hayden, Catherine P., Raleigh 1902 1904

Univ. Colo., 1894.

Haywood, F. J., Raleigh 1898

Bellevue Med. Coll., 1868.

Haywood, Hubert, Raleigh 1904

Bellevue Med. Coll., 1879.

Holding, S. P., Wake Forest 1897 1904

Bellevue Med. Coll., 1897.

Jenkins, C. L., Raleigh 1890 1892

Univ. N. Y., 1890.

K. C. MEDICAL SOCIETY. 893

Joined
Memhers and Address. Licensed. State

Society.

Johnson, K. W., Apex 1901 1904

Univ. Tenn., 1900.

Jordan, T. M., Raleigh 1881 1881

P. & S., Balto., 1881.

Judd, J. M., Cardenas 1898 1901

Balto. Med. Coll., 1897.

Knox, A. W., Raleigh 1878 1880

Bellevue Med. Coll., 1874.

Lewis, R. H., Raleigh 1877 1877

Univ. Md., 1871.

Marshburn, B. D., Raleigh, R. F. D. No. 7 1904

Nongrad. P. & S., Balto., 1875-6.

Marshburn, H. H., Neuse, R. F. D. No. 2 1904

P. & S., Balto., 1876.

McCullers, J. J. L., MeCullers 1886 1904

P. & S., Balto., 1886.

McGeachy, R. S., Raleigh 1894 1895

Bellevue Med. Coll., 1894.

McGee, J. W., Sr., Raleigh 1860 1865

Univ. Pa., 1860.

McGee, J. W., Jr., Raleigh 1888 1888

Bellevue Med. Coll., 1888.

McKee, James, Raleigh 1869 1870

Bellevue Med. Coll., 1869.

Moncure, Wm., Raleigh 1905 1906

Univ. Pa., 1904.

Pennv, J. A. J., Vanteen 1904

Univ. N. Y., 1861.

Powers, J. B., Wake Forest 1885 1904

Long Island Med. Coll., 1878.

Ray, O. L., Bangor 1899 1904

Univ. Coll. Med., Va., 1899.

Rankin, W. S., Wake Forest 1901 1901

Univ. Md., 1901.

Rogers, Jas. R., Raleigh 1886 1904

P. & S., Balto., 1886.

Royster, H. A., Raleigh 1894 1895

Univ. Pa., 1894.

Sexton, J. A., Fuquay Springs 1879 1904

Univ. Md., 1873.

Sorrell, L. P., Flint 1904

Med. Coll. Va., 1875.

Stephens, Ralph S., Raleigh 1905 1900

Univ. N. C, 1905

Thompson, S. W., Falls 1904

Med. Coll. Va., 1875.

Tucker, H. McKee, Raleigh 1899 1899

Univ. Md., 1899.

894 FirTY-riFTH annual session

Joined
Mcmiers and Address. Licensed. State

Society.

Templeton, J. M., Gary 1882 1904

Balto. Med. Coll., 1882.

Utley, B. S., Holly Springs 188G

P. & S., Balto., 1878.

Whitaker, Joel, Ealeigh 1905 1907

Univ. Md., 1900.

Wilkeison, Chas. B., Apex 1906 1907

Univ. N. C, 1906.

Young, L. B., Rolesville 1886 1907

P. & S., Balto., 1886.

WATAUGA-MITCHELL COUNTY SOCIETY.

President, J. W. Jones, Boone 1903 1904

U. S. Grant Univ., 1900.
Secretary, McD. Little, Horton 1904

Hodges, James M., Banner's Elk 1906 1906

Balto. Med. Coll., 1904.

Farthing, Logan E., Boone 1906 1906

Univ. N. C, 1906.

WARREN COUNTY SOCIETY.

President, P. J. Macon, Warrenton 1883 1901

Univ. Md., 1883 .
Secretary, Chas. H. Peete, Warrenton 1906 1906

Univ. Va., 1906.
Alston, Willis, Sr., Littleton 1869 1870

Univ. Md., 1869.
Alston, Willis, Jr., Littleton 1903 1903

Univ. Md., 1903.

Holt, T. J., Wise 1904 1904

Med. Coll. Va., 1904.

Perkins, F. E., Manson, R. F. D. No. 1 1906 1906

Univ. Buffalo, N. Y., 1905.

WASHINGTON-TYRRELL COUNTY SOCIETY.

President, W. H. Hardison, Creswell 1871 1904

Wash. Univ., Balto., Md., 1870.

Secretary, W. H. Ward, Plymouth 18S6 1900

Univ. Md., 1881.

Hallsey, B. F., Roper 1894 1900

Vanderbilt Univ., Nashville, Tenn., 1893.

Disosway, A. W., Plymouth 1905 1908

Univ. Md., Balto., 1905.

Hassell, Jas. L., Cresvi'ell 1889 1904

Coll. P. & S., Balto., 1886.

X. C. MEDICAL SOCIETY. 895

Joined
Members and Address. Licensed. State

Society.

Speight, J. W., Roper 1885 1904

Ky. School of Med., 1885.

Cohn, B. W., South Mills, Camden County 1901 1904

Med. Coll. Va., "1884.

WAYNE COUNTY SOCIETY.

President, W. W. Faison, Goldsboro 1883 1904

Jeff. Med. Coll., 1878.

Secretary, R. E. Lee, Goldsboro 1896 1900

Univ. Md., 1896.
Cobb, W. H. H., Sr., Goldsboro 1878 1878

Jeff. Med. Coll., 1861.

Kennedy, J. B., Goldsboro, R. F. D 1904

Univ. Nashville, 1870.

Exum, Wvatt P., Goldsboro, R. F. D 1902 1904

Med. Coll. Va., 1901.

Sutton, W. G., Seven Springs 1889 1896

Jeff. Med. Coll., 1889.

Roberts, J. D., Mt. Olive 1907 1904

Jeff. Med. Coll., 1SS9.

Roberts, J. D., Mt. Olive 1907 1904

Bellevue Med. Coll., 1875.

Kornegav, L. W., Mt. Olive 1906 1906

N. C. Med. Coll., 1906.

Person, E. Cooper, Pikcville 1905 1908

Med. Coll. Va., 1905.

Robinson, M. E., Goldsboro 1886

Wash. Univ., Balto., 1870.

Parker, J. Rainey, Goldsboro 1901 1903

Univ. Coll. Med., Rich., 1901.

Ginn, T. L. Goldsboro 1901 1904

Med. Coll. Va., 1901.

Spicer, William 1897 1904

Bellevue Med. Coll., 1898.

WILSON COUNTY SOCIETY.

President, B. S. Herring, Wilson 1901 1901

Univ. Mich., 1901.

Secretary, A. F. Williams, Wilson 1901 1905

Univ. Md., 1901.

Dickinson, E. T., Wilson 1895 1900

Med. Coll. Va., 1895.

Moore, C. E., Wilson 1875 1875

Bellevue Med. Coll., 1875.

Anderson, W. S., Wilson 1899

Washington Univ., 1867.

896 FIFTY-FIFTH ANNUAL SESSION

11^ 7, 7.^7 Joined

Members and Address. Licensed. State

Society.

Anderson, W. H., Wilson J905 jgQr

Univ. Va., 1902.

Crocker, S. H., Stantonsburg I399 jggg

Ky. School Med., 1894.

Lamm, I. W., Lueania I900 1900

Univ. Coll. Med., 1899.

Moore, E. G., Elm City 1890 is90

Univ. Md., 1883.

Harrison, J. S., Elm City I905 1908

Med. Coll. Va., 1903.

Barnes, B. F., Elm City I9O2 1902

Univ. Md., 1902.

Best, Henry, Wilson I907 1908

Univ. N. C, 1907.

WILKES COUNTY SOCIETY.

President, J. M. Tinner, Wilkesboro 1904

Univ. Louisv., Ky., 1881.
Secretary, John Q. Myers, North Wilkesboro 1904 1904

N. C. Med. Coll., 1904.
Gilreath, F. H., North Wilkesboro 1898 1898

Univ. Nashville, 1898.
Horton, W. P., North Wilkesboro 1896 1904

Balto. Med. Coll., 1892.

Duncan, J. E., North Wilkesboro 1907 1908

Univ. Coll. Med., Rich., Va., 1907.

Somers, L. P., Osbornville I9O4

Pegram, R. W. S., Dellaplane

White, J. W., Wilkesboro 1889 1890

Jeff. Med. Coll., Phila., 1889.
Eller, A. J., Reedy Branch 1895 1904

P. & S., Balto., 1893.

YADKIN COUNTY SOCIETY.

President, T. R. Harding, Yadkinville 1885 1906

P. & S., Balto., 1885.

Secretary, M. A. Royall, Yadkinville 1904

P. & S., Balto., 1885.

Shore, T. W., Boonville Ig99 1904

Univ. Richmond, 1898.

Fassett, B. W., Yadkinville 1899 1904

Balto. Med., 1898.

Holcomb, C. M., Chestnut Ridge 1905

P. & S., Balto., 1869.

Blackwell, T. L., Boonville I9O5

Louisv. Med. Coll., 1874.

N. C. MEDICAL SOCIETY.

Members and Address. Licensed.

Clingman, J. J., Huntsville

P. & S., Balto., 1877.

Leak, W. G., East Bend 1900

N. C. Med., 1900.

Russell, S. L., Yadkinville 1889

Univ. Tenn., 1892.

Hutchens, E. M., Boonville 1896

N. C. Med. Coll.

Salmans, H. C, Jonesville 1904

N. C. Med. Coll., 1904.

YANCEY COUNTY SOCIETY.

President, J. L. Eay, Burnsville 1887

Coll. P. & S., Balto., 1887.

Edwards, C. P., Burnsville 1903

Tenn. Med. Coll., 1902.

Ewing, J. B., Boonford 1905

Independent Med. Coll.

Robertson, W. B., Burnsville 1907

Balto. Med., 1898.

897

Joined

State

Society.

1904
1904
1904
1904
1908

1890
1903
1907
1908

898

laFTY-i'IFTH ANNUAL SESSION

Honorary Fellows. Medical Society of the State of North Carolina.

Name.

Address.

H. T. Bahnson

W. \V. Lane

W.J Love

Wilmino'ton

James McKee

Ealei"^h

AVillis Alston

J.ittleton

W. .1. H. Bellamy

W. I. Koyster

Wilmington.

Raleigh.

Wilmington.

New Bern.

Salem.

H eiiil erson

Georjie U. Thomas

Francis Dnfly

J. F. yhafi'ner

B. P. Alston

W. J. Jones

F. J. Haywood

P. A. Barrier

Goldsboro.
h'aleigh.
Mount Pleasant

Geo. W. J,ong

Ciraham

E. H. Speight

R. J. Noble

Whitakers.
Selnja

W. H. Whitehead

Rocky Mount.
Wilmington.

D. W. Bullock

L. H. Hill

L J. Picot

K. H. Lewis

Raleigh.
Rale.gii.
R<ilei"'h

J. W. Mciiee

VVm. H. H. Cobb

I. W. Faison

Goldsboro.
Charlotte.

C. E. Moore

Wilson.

Henry lull

Kinston.

Honorary Members. Medical Society of the State of North Carolina.

Name.

L. McL. Tiffany...

W. W. Keen

J. Alhson Hodges

R. L. i^Myne

W. L. Robinson ...
J. N. McCormack
J. C. Walton

Address.

Baltimore, Md.
Philadelphia. Pa.
KichmonH. Va.
Norfolk, Va.
Danville, Va.
Bowling Green, Ky.
Danville, \'a.

June. 190.'^. Total membeT.ship Medical Sopiety of the State of North rarolina inrrlud-
ins .'iL'ven honorarv member.';. 1. 01. Ol the 9S onuiiiies of the Stxte i lie t'h\ .-leijiii.^ of it■^
■ronniies are oraaii'zpfi in county societies in aifiliitlioii with and component branches of
the Slate Medical Socieiy

Three hundred ant1 seventy two member?; resistered at If'OS session. This number
does not include applicants for license, visitors, solicitors or others ihau enrolled mem-
bers.

APPENDIX.

Physicians Licensed by the North Carolina State Board
of Medical Examiners from the Organization of the
Board in 1859 to 1908 Inclusive.

(Comi«led from the Original Records by a Former Secretary.)

1st session— June, 1S59, Raleigh.

Name and College of Graduation. Address at Time Lieensed.
Coke, Lucius C Halifax County

2d session— May, 18G0, Raleigh.

Blount, W. A Washington

Cox, C. G Onslow County

Dunn, W. A Wake County

Ennett, Geo. N Onslow County

Harris, H. H Wake County

Leary, J. H Bertie County

Lilly, W. H Richmond County

McCombs, J. P Charlotte.

McKenzie, W. W Salisbury

McGee, J. W Kenansville.

Petway, R. S Edgecombe County

Robinson, L. W Sampson County

Shaw, D. W Moore County

Shinn, J. W Rowan County

Somers, W. D New Hanover County

St Clair, P. Fd New Hanover County

Warren, L. P Edenton.

3d session— ^May, 1861, Morganton.

Barrier, P. A Mt. Pleasant

Fuller, J. T Person County

Gaither, H. W Gaston County

Gidney, J. C Shelby

Hill, Calhoun Duplin County

Love, Wm. J Wilmington

*Thp nrlrlnss iinti-d is that of the iiiiplicHiit ns tiveii at the time of bt-inif liccn-eil —
mfliiy hiivp -ii'oe r-hnnsri d and nutnhprs hav^ dit'rt, but it was tliouirht bi'st lo make 'he
list eomplete cont'iiniiiR the name of all recDrdcd in the books kept by the Hoard. The
colleL'c information was not kept in the early history ofthn Hoard nor were the grades
made on 'xanvnation recorded "ntil IK9!). TtiPname> of those m>»kiiig ihe 'highest
fcore" from 1S<) to l^'^O. with much "therinstrnctivedata were noted in a^History of the
work do-'e by the Kifth Hoirl of M-'dical Exa'tiinors" bv Dr. Francis Dnffy and pnb-
li-hcd in ^■ohlme xxxiii, N ('. Medical Journal Nongrad nates were admitteil alsoio
examination up to the vear liK'O. Quite a numticr of g-entlemen. it will be noted, were
licen-ed when unfliTgradnHtcs In a verv larsje majoritv of >nch Instances it is worthy of
mention the licentiates continued ttieir studies and graduated from reputable medical
colleges.— J. H. W.

900 APPENDIX.

Uaine and College of Graduation. Address at Time Licensed.

Lawing, J. M Mecklenburg County

Pearson, R. C Morganton

Scales, N. M Wilkes County

Sheppard, J, C New Hanover County

Shinipock, R. A Mecklenburg County

Tate, H. W Morganton.

4th session— May, 1862, Raleigh.
Berry, David Burke County

(The war of secession intervening, no session of the board was held
until 1SG6, when the board met in Raleigh in fifth session, but no one
appeared for examination.)

6tii session— April, 1867, Raleigh.

Wood, Thos. F Wilmington

Powell, Thos. C Raleigh

7Tn SESSION— April, 1868, Tarboro.

Gotten Joseph Scotland Neck

Dowd, C. F Raleigh

Kirby, Geo. L Goldsboro

8th session— May, 1869.

Alston, Willis Littleton

Bahnson, Henry T Salem

King, Joel G Warrenton

Montague, Alex Rolesville

McKee, James Raleigh

Royster, Wisconsin Illinois Raleigh

Staton, J. L Tarboro

Sugg, J. P Tarboro

9th SESSION— May, 1870.

Cowan, Robt. L Rowan County

Ennett, W. T New Hanover County

Graham, IMcL New Hanover County

Kerr, Chas New Hanover Covmty

Lewis, R. F Robeson County

10th SESSION— May, 1871, Raleigh.
Thomas, Geo. G Wilmington

llTH SESSION— May, 1872, New Bern.

Attmore, G. S New Bern

Duffy, Francis Richlands, Onslow County

12Tn SESSION— May, 1873, Statesville.

Carr, Albert G Wake County

Cowan, Robt. L Salisbury

Gaither, J. B Salisbury

IS'. C. MEDICAL SOCIETY. 901

Natne and College of Graduation. Address at Time Licensed.

Green, Isaac E Warrenton

Hadley, J. M Lenoir County

Johnson, W. G Davie County

Murphy, P. L Wilmington

McLenden, W. J Wadesboro

Vick, J. W Selma

13th session— May, 1874, Charlotte.

Ardrey, Joseph A Pineville

Bass, H. Turner Scotland Neck

Foster, E. S Louisburg

Fowler, Robert H Ealeigh

Hall, J. B Scotland Neck

Moore, Thos. B Charlotte

Wilder, Hillary M Raleigh

14th session— May, 1875, Wilson.

Bullock, D. W Tarboro

Cooke, W. J Louisburg

Eagers, C. W Sparta

Grimes, R. J Robersonville

Moore, C. E Battleboro

Land, H. G Currituck County

Murphy, W. C Clinton

Picot, L. J Littleton

Sills, R. A Nashville

Speight, R. H Tarboro

Thorpe, F. I Rocky Mount

Taylor, Joshua Tarboro

Whitehead, W. H Battleboro

15th SESSION-^May, 1876, Fayetteville.

DeRossett, M. I Wilmington

McNeill, Jas. W Fayetteville

McMullan, Jno. H Hertford

McKimmon, Wm. H Fayetteville

McMillan, Jno. D Lumberton

Murdock, Wm. A Rowan County

Tull, Henry Kinston

16th SESSION— May, 1877, Salem.

Alford, H. M Greensboro

Beeker, E. Nelson Clayton

Bitling, J. A Germanton

Graham, Geo. W Raleigh

Griffith, J. F Clemmonsville

Hill, L. H Germanton

Hunt, L. G Huntsville

902 APPENDIX.

Name and College of Graduation. Address at Time Licensed.

Lewis, Richard H Raleigh

Long, Geo. W Graham

Roberts, J. D Mt. Olive

Roan, Preston Winston

Snivers, N. S Salem

Scales, Jeff Reidsville

Wilhelm, W. W Morrisville

Wilson, W. R Townsville

17th session— May, 187S, Goldsboro.

Barringer, Paul B Charlotte

Bryan, C. G Rich Square

Cobb, Wm. H. H Goldsboro

Faison I.. Wellington Fulton

Gregory, Richard K Greensboro

Hornaday, E. A Willow Grove

Jones, W. W Raleigh

Knox, A. W Raleigh

Lyon, D. Stuart Charlotte

Lee, Algernon M Clinton

MeClellan, J. R Mooresville

McLean, Peter Shoe Heel

Noble, Richard J Selma

Pollock, Jno. A Kinston

Tucker, Jno. H Henderson

IStii session— May, 1879, Greensboro.

Abernathy, Wm. Lafayette Hickory

Anderson, Thos. Eli Statesville

Beall, Wm. P Greensboro

Balsley, Turner E Greensboro

Bradsher, Chas. Edward Person County

Baker, Julian M Tarboro

Battle, CM Rocky Mount

Burgin, Henry F Swanannoa

Cook, Wm. Franklin Jamestown

Cox, Joseph Jno New Garden

Covington, James M Rockingham

Freeman, Richard A Alamance County

Glenn, Chas. M Greensboro

Gilbert, Wm. Jay Fremont

Gunn, James L Yancey ville

Harris, Wartlett Y High Point

Hargrove, Robt. H Robersonville

Haywood, Hubert, Bellevue Med. Coll., 1879 Raleigh

Hollingsworth, Wm. Robt., Jeff. Med. Coll., 1877 Mt. Airy

X. C. MEDICAL SOCIETY. 903

'Name and College of Graduation. Address at Time Licensed.

Johnson, Norman M., Washington Univ., Balto., 1870 Durham

Jones, Simmons B., Univ. of Va., 1878 Charlotte

Lee, Henry W., Univ. of Pa., 1876 Ealeigh

Lindsay, Edward, Univ. of Va., 18G9 Greensboro

Mercer, Wm. P., Univ of N. Y., 1879 Toisnot

McDonald, Alexander D., Wash. Univ., Balto., 1877 Wilmington

Prince, David M., Med. Coll. of S. C, 1871 Laurel Hill

Robinson, O. P., Bellevue Med. Coll., 1877 Fayetteville

Swindell, Chas. A., Wash. Univ., Balto., 1879 Greenville

Stafford, Wm. Gaston, Xongraduate, 1 course Orange County

Sexton, Jas. A., Univ. of Md., 1873 Raleigh

Speed, Edward A., Wash. Univ., Balto., 1869 Person County

Sledge, James Thos., Univ. of Md., 1877 Warren County

Stevenson, Sam"l Whitfield, Wash. Univ., Balto., 1869 Mooresville

Trantham, Henry T., Univ. of N. Y., 1875 Salisbury

Walton, John C, Louisville Med. Coll., 1878 Prospect Hill

Winston, Jno. Thos., Univ. of Md., 1875 Youngsville

19x11 SESSION— May, 1880, Wilmington.

Adams, Robt. Harris, Louisville Med. Coll., 1875 Gastonia

Anders, Wm. King, Phila. Univ., 1870 Gravel Hill

Burbank, Thos. S., nongraduate, 1 course Wilmington

Collins, Jno. A., Bellevue, 1869 Enfield

Dillard; Richard Jr., Jeff. Med. Coll., 1879 Edenton

Frontis, David B., Univ. of Md., 1878 Lexington

Galloway, Walter C, Wash. Univ., Balto., 1874 Snow Hill

Herring, Needham Brj^an, Univ. of N. Y., 1801 Toisnot

Hill, Melmoth Wilson, Wash. Univ., Balto., 1869 Statesville

Harris, Thos. W., Univ. of N. Y., 1868 Chapel Hill

Huntley, Abel Braxton, Coll. P. & S., Balto., 1879 W^idesborough

Hunter, Lester Walter, Bellevue, 1875 Charlotte

Irwin, John, Louisville Med. Coll., 1878 Villa Franca

Ivy, Henry Tracy, Med. Coll. of S. C, 1880 Fayetteville

Matthews, Geo. E., Wash. Univ., Balto., 1870 Ringwood

Montague, Seth J., Bellevue, 1872 Winston

McXider, St Clair V., Wash. Univ., Balto., 1879 Jackson

Nicholson, James L., Univ. of N. Y., 1870 Richlands

Powers, Kinchen Jones, Wash. Univ., Balto., 1875 Pender County

Powers, Luther Milton, Wash. Univ., Balto., 1877 Plymouth

Pool, Chalmers M., Coll. P. & S., Balto., 1880 Salisbury

Speed, Eugene T., Washington Univ., Balto., 1875 Tarboro

Schoonwald, John T., Long Island Med. Coll., 1879 Wilmington

Stancill, John McQ., Univ. of Md., 1872 Rockingham

Whitehead, John, Univ. of Penn., 1880 Salisbury

West, Geo. H., Univ. of N. Y., 1872 Newton

904 APPENDIX.

20th session— May, 1881, Asheville.

Name and College of Graduation. Address at Time Licensed.

Battle, Adolphus J., Coll. P. & S., Balto., 1881 Earpsboro

Brownson, Wm. C, Univ. of N. Y., 1878 Asheville

Betts, Henry Watson, Univ. of N. Y., 1878 Albemarle

Baynes, Ralph S., Coll. P. & S., Balto., 1879 Person County

Cain, D. J., Med. Coll. of S. C, 1838 Asheville

Crump, VVm. L., Jeff. Med. Coll., 1879 Rowan County

Crowell, Thos. A., Jeff. Med. Coll., 1875 Monroe

Craigmiles, James G., Vanderbilt University, 1881. . . .Buncombe County

Faison, James H., Bellevue, 1881 Faison

Fletcher, Marshall Hall, Bellevue, 1881 Shufordsville

Gardner, Chas. K., Med. Coll. of Va., 1880 Laurinburg

Hunt, Chas. W., Coll. P. & S., Balto., 1880 Brevard

Hilliard, William David, Jeff. Med. Coll., 1878 Asheville

Gentry, Levi C, Univ. of N. Y., 1860 Ashe County

Jordan, Thos. Murphy, Coll. P. & S., Balto., 1881 Hillsboro

Lilly, Henry W., Univ. of Va., 1878 Fayetteville

Lyle, Sam'l Harley, nongraduate, 1 course, Vanderbilt Univ. .. .Franklin

Lackey, Reuben L., S. C. Med. Coll., 1881 Amity Hill

Moore, Jno. Wesley, Coll. P. & S., Balto., 1880 Cabarrus County

Meisenheimer, Theo. F., Univ. of N. Y., 1880 Stanly County

McCorkle, Jno. Macon, Jeff. Med. Coll., 1880 Newton

McKenzie, Jno. Chas., Jeff. Med. Coll., 1877 Laurel Hill

McMillan, Jno. Luther, Univ. of Md., 1881 Robeson County

Norcop, Percy T., Univ. of Edinburgh, 1876 Asheville

Payne, Robt. Lee, Jeff. Med. Coll., 1881 Lexington

Parr, Albert Dunn, Coll. P. & S., Baito., 1881 Wake County

Pharr, Theo. F., Bellevue, 1875 Concord

Phillips, Matt Dalton, Univ. of N. Y., 1880 Stokes County

Reagan, Wm. Latta, Coll. P. & S., Balto., 1879.

Robinson, Frank, Bellevue, 1879 Gastonia

Robinson, Thos. Booker, Bellevue, 1879 Wake County

Staton, James R., Bellevue, 1880 Tarboro

Walde, Sam'l P., Univ. of Nashville, 1868 Wake County

Whitesides, Benj. F., Univ. of Md., 1877 Hickory

Wilson, Robt. I., Univ. of N. Y., 1879 Swannanoa

Williams, Jno. Hay, Univ. of Iowa, 1862 Asheville

Weaver, Henry Bascom, "Washington Univ., Balto., 1872 Weaverville

Winston, Cornelius Franklinton

2 1st session— May, 1882, Concord.

Anderson Chas. Felix, Louisville Med. Coll., 1882 Mocksville

Battle, Kemp P. Jr., Univ. of Va., 1881 Chapel Hill

Bradshaw, Wm. G., Coll. P. & S., Balto., 1881 Lexington

Clingman, Jno. J., Univ. of Md., 1876 Huntsville

N. C. MEDICAL SOCIETY. 905

Xamc and College of G-raduation. Address at Time Licensed.

Ferguson, Henry B., Jeff. Med. Coll., 1882 Littleton

Gunter, Jno. B., Jeff. Med. Coll., 1882 Durham

Irwin, Jno. R., Univ. of Md., 1879 Alexadriana

Kirkman, L. E., Louisville Med. Coll., 1875 Smitlifield

Lloyd, Geo. S., Univ. of Md., 1881 Tarboro

Morrison, Eobt. H., Louisville Med. Coll., 1881 Shelby

Meisenheimer, Chas. A., Univ. of IST. Y., 1881 Cabarrus County

McBrayer, Jno. H., Atlanta Med. Coll., i882 Cleveland County

Eoyster, Thos. S., Bellevue, 1882 Henderson

Strickland, James T., Jeff. Med. Coll., 1882 Surry County

Templeton, James M., Balto. Med. Coll., 1882 Dallas

Smith, Roger E., Bellevue, 1882 Princeton

Wilson, Albert R., Jeff. Med. Coll., 1882 Greensboro

Whittington, Willard P., Coll. P. & S., Balto., 1882 Burnsville

Young, Robt. S., Univ. of N. Y., 1881 Matthews

22u SESSION— May, 1883, Tarboro.

Anderson, James H., Univ. of N. Y., 1882 Tarboro

Braswell, James C, Univ. of Md., 1883 Whitakers

Bunn, Maurice 0., Univ. of N. Y., 1883 Wilmington

Boddie, Needham P., Coll. P. & S., Balto., 1883 Palmyra

Bobbitt, Wm. H., Coll. P. & S., Balto., 1882 Rockingham

Clark, Henry I., Univ. of Md., 1879 Hamilton

Faison, Wm. W., Jeff. Med. Coll., 1878 Goldsboro

Ferguson, Kenneth M., Coll. P. & S., Balto., 1882 Manchester

Edwards, Grandison C, Bellevue, 1883 Hooker ton

Gregory, Oscar, Jeff. Med. Coll., 1854 Halifax

Harris, Fletcher R., Univ. of Va., 1881 Henderson

Hudson, Wm. L., Kentucky School of Med., 1876 Hawley's Store

Hodges, James M., Bellevue, 1883 Mount Olive

Johnson, Seth T., Univ. of N. Y Tarboro

Marriott, Henry B., Univ. of Md., 1883 Battleboro

Macon, Philemon J., Univ. of Md., 1883 Warrenton

Moore, Edwin G., Univ. of Md., 1883 Toisnot

McLean, Xeil M., Coll. P. & S., Balto., 1883 Robeson County

McNeill, Dan'l B Brunswick County

McDowell, Wm. O., Univ. of Pa., 1876 Scotland Neck

Long, Benj. L., Univ. of Md., 1881 , Hamilton

Rogers, Sion H., Bellevue, 1883

Street, Nathan H., Univ. of Va., 1880 Pollocksville

Stevens, Jno. A., Jeff. Med. Coll., 1883 Clinton

Summerell, E. Mitchell, Univ. of Penn., 1883 Salisbury

Smith Weldon Scotland Neck

Scarborough, James H., Coll. of P. & S., Balto., 1882 Trenton

Schenek, Dodson R., Jeff. Med. Coll., 1883 Guilford County

90 G APPEIs'DIX.

Name and College of Graduation. Address at Time Licensed.

Taylor, Isaac M., Coll. P. & S., New York, 1882 Chapel Hill

Whitaker, Henry H., Univ. of Md., 1883 Battleboro

VVimberly, Geo. L., Univ. of Md., 1883 Tarboro

23d session— May, 1884, Ealeigh.

AdamH, M. K., Univ. of Md., 1878 Iredell County

Battle, J. T. J., Coll. P. & S., Balto., 1884 Johnston County

Burroughs, James A., Louisville Med. Coll., 1884 Asheville

Brown, Frank W., Bellevue, 1883 Greenville

Best, B. W., Coll. P. & S., Balto., 1884 Pitt County

Dixon, R. E. L., Jeff. Med. Coll., 1884 Wilmington

Edwards, William, Coll. P. & S., Balto., 1884 Nash County

Freeman, W. G., Univ. of Penn., 18G1 Murfreesboro

Futrell, M. H., Coll. P. & S., Balto., 1884 Murfreesboro

Gray, Robah F., Louisville Med. Coll., 1877 Winston

Grimsley, Jos. Edgar, Univ. of Va., 1883 Snow Hill

Henderson, Richard B., Univ. of Md Warren County

Herron, Alexander, Med. Coll.* of S. C, 1881 Charlotte

Long, Jno. Wesley, Vanderbilt University, 1883 Eandleman

Manning, John M., Bellevue, 1882 Pittsboro

Murray, Hosea P., Coll. P. & S., Balto., 1884 Wallace

McCumber, Jno. L., Long Island Med. Coll., 1883 Wilmington

McMillan, Benj. F., Univ. of Md., 1882 Robeson County

McSwain, T. C, Coll. P. & S., N. Y., 1884 Fayetteville

Pender, Wm. Dorsey Martin County

Pritchard, Wm. Broaddus, Coll. P. & S., Balto Wilmington

Perry, Mark P., Coll. P. & S., Balto., 1884 Macon

Purefoy, Geo. W., Jeff. Med. Coll., 1876 Chapel Hill

Richardson, W. E., Univ. of Pa., 18U8 Wake County

Robinson, Geo. J., Jeff. Med. Coll., 1884 Smithfield

Spicer, James, Bellevue, 1884 Goldsboro

Sikes, Ginnada Thos., Univ. of Md., 1884 Grissom

Sasser, Louis L., Univ. of Va., 1883 Smithfield

Smith, Julian A., Univ. of N. Y., 1883 Wilmington

Williams, Herbert C, Coll. P. & S., Balto., 1882 Johnston County

White, Edmund Thos., Vanderbilt Univ., 1882 Oxford

Whitfield, Wm. Cobb, Univ. of Md., 1884 Seven Springs

Whitley, Virgil A., Univ. of Md., 1884 Norwood

Williams, T. B., Univ. of Md., 1877 Ridgeway

24th SESSION— May, 1885, Durham.

(Members board present: Drs. W. R. Wood, J. A. Reagan, A. W.
Knok, P. L. Murphy, F. Duffy and W. J. H. Bellamy.)

Ashe, Edmund S., Coll. P. & S., Balto., 1885 Wadesboro

Ashby, Thos. B., Coll. P. & S., Balto., 1885 Mt. Airy

N. C. MEDICAL SOCIETY. 907

XaiJie and College of Graduation. Address at Time Licensed.

Archey, Leon M., Coll. P. & S., Balto., 1880 Concord

Alexander, Annie Louise, Woman's Med. Coll., Philada., 1884,

Mecklenburg County

Adams, Clias. Ed., Univ. of Md Gastonia

Atwater, Alfred S., Vanderbilt University, 1885 Chatham County

Bell, James S., Univ. of Md., 1884 Matthews

Booth, Samuel D., nongraduate, 1 course, Med. Coll., Va., 1867. . .Oxford

Booth, Patrick, Med. Coll. of S. C, 1875 Knap of Reeds

Bullock, Thos. C, Coll. P. & S., Balto., 1885 Blockersville

Benton, James H., Univ. Pa., 187G Newton Grove

Brown, Z:ino, Bellevue, 1883 Greenville

Bolton, Mayland, Jeflf. Med. Coll., 1885 Rich Square

Crisp, Wm. B., Coll. P. & S., Balto., 1885 Coffee

Carr, John B., Univ. of Md., 1885 Old Sparta

Cooper, Fleet John, Coll. P. & S., Balto., 1884 Hives

Cope, Geo. C, Coll. P. & S., Balto., 1885 Rowan County

Dew, Samuel B., Univ. of Md., 1885 Wilson

Dalton, David N., Univ. of N. Y., 1881 Winston

Dodson, Henry H., Med. Coll. of Va., 1882 Milton

Faison, John M., Univ. of Va., 1884 Faison's

Ferrebee, Edwin B., Coll. P. & S., Balto., 1885 Belcross

Hardee, P. R., Coll. P. & S., Balto., 1885 Durham

Harrell, James Joseph, Univ. of Md., 1883 Gulf

Hicks, Maltis L., Coll. P. & S., Balto., 1885 W^rkefield

Harrell, William H., Med. Coll. of Va., 1885 Williamston

Hathaway, Burton W., Louisville Med. Coll., 1885 Edenton

Hays, James Mcintosh, Med. Coll. of S. C, 1883 Wilton

Harding, Thos. R., Coll. P. & S., Balto., 1885 Huntersville

Jordan, David B., Jeff. Med. Coll., 1885 Grantham's Store

Klutz, Paul J., nongraduate, 1 course. Coll. P. & S., Balto., 1885,

Gold Hill

Keever, Adolphus P., Jeff. Med. Coll., 1882 Keeversville

Knight, Josiah B. H., Coll. P. & S., Balto Eagle Pass

Lucas, David, Balto. Med. Coll Enfield

Maynard, Atlas A., Coll. P. & S., Balto., 1883 Clayton

Montgomery, Samuel L., Univ. of N. Y., 1879 Monroe

McKay, Joseph Foy, Med. Coll. of S. C, 1884 Averysboro

McLeod, Gilbert, Univ. of Md., 1882 Anson County

Nance, Geo. B., Jeff. Med. Coll., 1885 * Olive Branch

Nicholson, John T., Coll. P. & S., Balto., 1885 Bath

Nicholson, Samuel T., Coll. P. & S., Balto., 1881 Washington

Pate, Wm. T., Coll. P. & S., Balto., 1885 Laurel Hill

Parris, David C, Atlanta Med. Coll., 1882 Hillsboro

Perry, James C, Univ. of Md., 1885 Newbegun

Pharr, Wm. W., Coll. P. & S., Balto., 1881 Query's

Pratt, Chas. S., Coll. P. & S., N. Y., 1884 Raleigh

908 APPENDIX.

Name and College of Graduation. Address at Time Licensed.

Powell, Wm. E., Coll. P. & S., Balto.. 1882 Greene County

Ritter, Fred. W., nongraduate, 1 course, Coll. P. & S., Balto Shiloh

Reinhart, Dabney B., nongraduate, Univ. of Va Thomasville

Sraallwood, John P., Univ. of Md., 1885 Leinston

Spruill, Wm. T., Univ. of Md., 1885 Youngsville

Sloan, Henry, Med. Coll. of S. C, 1879 Lisbon

Sawyer, Chas. W., Univ. of Md., 1885 Elizabeth City

Summerfield, Hugh W., Louisville Med. Coll., 1870 Guilford County

Tayloe, David Thomas, Bellevue, 1885 Washington

Turlington, Willis E., Coll. P. & S., Balto., 1884 Elevation

Wilson, Wm. Hill, Louisville Med. Coll., 1885 Dallas

Williams, Egbert P., Univ. of Va., 1881 Cedar Creek

Whitesides, Joseph C, Univ. of Md., 1877 Bridgewater

Whittaker, Romulus A., Coll. P. & S., Balto., 1885 Trenton

Webb., Benj. G., Louisville Med. Coll., 1885 Asheville

White, Thos. Newby, Coll. P. & S., Balto., 1882 Belvidere

Baird, John H., nongraduate Briggsville

Brank, Joseph B., nongraduate, 1 course, Atlanta Med. Coll., 1884,

Weaverville

Coleman, Joseph Ira, Coll. P. & S., Balto., 1885 Hurdle's Mills

Caldwell, Daniel G., Univ. of Md., 1885 Charlotte

Covington, Furman P., Univ. of N. Y., 1885 Norwood

Dorsett, Harrison W., nongraduate Jeflf. Med. Coll., 1 course, 1861,

Bethany

Emmitt, John M., Univ. of Md., 1885 Hope Mills

Goley, Wm. R., Coll. P. & S., Balto., 1885 Long Branch

Hughes, Francis W., Univ. of Pa., 1880 New Bern

Hill, Albert A., nongraduate 1 course, Jeff. Med. Coll., 1855. .Lexington

Jordan, Arch. C, Coll. P. & S., Balto., 1881 Caldwell Institute

Littleton, John Wm., Coll. P. & S., Balto., 1885 Albemarle

Muller, Robt. L., Louisville Med. Coll., 1884 Ringvvood

Nichols, Chas. G., nongraduate, Bellevue, 1880 Mt. Tirzah

Fox, Millard F., Coll. P. & S., Balto., 1881 Greensboro

Leggett, Kenelm, Ky. School of Med., 1884 Palmyra

Rogers, Joseph E., So. Med. Coll., Ga., 1885 Alexander

Hodges, James A., Univ. of Va., 1883 Fayetteville

Person, Addison G., Coll. P. & S., Balto., 1885 Fremont

Wise, James A., nongraduate, 1 course. Coll. P. & S., Balto., 1880,

Red Mountain

Kennedy, Wm. P., Univ. of Md., 1885 Warsaw

Powers, John B., Long Island Med. Coll., N. Y., 1878 Wake Forest

24TII SESSION (Adjourned) — ^August, 1885, Raleigh (and Adjourned
Session at Asheville Next Day Combined ) .
(Members of Board present: Drs. Knox, Wood, Bellamy, Reagan,
Murphy and Duff,y. )

Allen, Rufus L., Univ. of Md., 1885 Waynesville

Abernathy, Jacob F., nongraduate, 1 course, Louisville, 1882. . . .Murphy

N. C. MEDICAL SOCIETY. 909

Name and College of Graduation. Address at Time Licensed.

Anderson, James Robt., Univ. of La., 1882 Lincoln County

Broughton, Leonard G., Ky. School of Medicine, 1885. . . .Wilson County

Brougliton, Chas. V., KJ^ School of Medicine, 1885 Wilson County

Beall, James F., nongraduate, 1 course, Univ. of N. Y., 1865,

Davidson County
Bulla, Alexander, nongraduate, 1 course, Jeff. Med. Coll., 1855,

Davidson County

Bagwell, Wm. H., Coll. P. & S., Baltc, 1883 Pactolus

Bennett, Aurelius M., nongraduate, 1 course, Med. Coll. of Va., 1884,

Jackson County

Couneill, Jeff. B., Coll. P. & S., Balto., 1885 Watauga County

Cooper, Abner T., Coll. P. & S., Balto., 1884 Clinton

Doughton, George, Coll. P. & S., Balto., 1884 Alleghany County

Gibson, McW., Univ. of Md., 1884 Statesville

Hill, James Davidson County

Harris, Isaac A., nongraduate, 1 course, Jeff. Med. Coll., 1860,

Buncombe County

Ivy, Will Parsons, Univ. of Md., 1883 Catawba County

Little, H. McD Alexander County

Lovelace, Thos. B., Coll. P. & S., Balto., 1883 Rutherford County

Kent, Alfred A., Jeff. Med. Coll., 1885 .Lenoir

Killian, Benj. R., Louisville Med. Coll., 1885 Alexander County

Littlejohn, Eugene M., Balto. Med. Coll., 1885 Warrenton

Lewis, Geo. William, nongraduate, 1 course, Univ. of Md., 1885,

Nash County

Lucas, Jesse B., Univ. of Md., 1875 Sampson County

Patton, John W., nongraduate, 1 course, Univ. of Nashville, 1879.

Phillips, Jordan B., Med. Coll. of S. C, 1884 Watauga County

Pearsall, Jere R., nongraduate, 1 course, Univ. of Va., 1883. .Morganton
Robbing, Alex. H., nongraduate, 1 course, Med. Col. of S. C, 1857,

Brunswick County

Rozzelle, Chas. S., nongraduate, 1 course, Univ. of Pa., 1874,

Lincoln County
Straw, John Robert, nongraduate, 1 course. Coll. P. & S., Balto., 1884,

Ashe County

Speight, John Wesley, Ky. School of Med., 1885 Hertford County

Tilson, Jacob C, nongraduate, 1 course. Coll. P. & S., Balto., 1881,

Madison County
Teague, James H., nongraduate, 1 course, Jeff, Med. Coll., 1881,

Jackson County
*Way, Joseph Howell, ncfngraduate, 1 course, Med. Coll. of Va., 1884,

Asheville
Young, G. E., nongrad., 1 course, Univ. of Pa., 1858. .Rutherford County
Lowry, F. W., Univ. of Md., 1883 Pasquotank County

*Made highest grade.— N. C. Medical Journal, Vol. xxxiii, p. 50.

910 APPENDIX.

25TII SESSION— May, 1886, New Bern.

(Members of Board present: Drs. W. R. Wood, J. A. Reagan, W. J. H.
Bellamy, A. W. Knox, W. Alston, F. Duffy and P. L. Murphy.)

Name and College of Graduation. Address at Time Licensed.

Armond, John McD., Univ. of Md., 1880 Mecklenburg County

Bufialoe, A. J., Bellevue, 188(3 Raleigh

Braswell, M. R., Univ. of Md., 1886 Rocky Mount

Black, James C, Univ. of Md., 1886 Cabarrus County

Burt, Benj. W., Coll. P. & S., Balto., 1886 Wake County

Boyette, James M., Coll. P. & S., Balto., 1885 Cumberland County

Chapin, Hiram T., Louisville Med. Coll., 1880 Chatham County

Clark, K. M., Balto. Med. Coll., 1885 Vance County

Cox, Benj. F., Coll. P. & S., Balto., 1886 Palmersville

Crawford, Wm. B., Bellevue Med. Coll., 1880 Goldsboro

Faison, J. Alexander, Jeff. Med. Coll., 1880 Wayne County

Foard, Fred. T., Louisville Med. Coll., 1886 Catawba County

Gates, F. P., Bellevue Med. Coll., 1886 Lenoir County

Harris, John H., Bellevue Med. Coll., 1880 Wake County

Gurken, Chas. R., Univ. of Pa., 1885 Jonesville

Hassell, Starke, Coll, P. & S., Balto., 1880 Tyrrell County

Hollingsworth, Ed. M., Coll. P. & S., Balto., 1880 Mt. Airy

Hollingsworth, J. M., Coll. P. & S., Balto., 1880 Mt. Airy

Ingraham, Chas. B., Jeff. Med. Coll., 1886 . .Montgomery County

Kernodle, G. W., Coll. P. & S., Balto., 1880 Alamance County

Leary, Thomas H., Univ. of Md., 1886 Edenton

Monroe, John P., Univ. of Va., 1885 Durham

Moore, John L., Coll, P. & S., Balto., 1886 Halifax County

Moore, Brutus C, Jeff. Med. Coll., 1886 Anson County

Mann, J. J., 1 course, Balto. Mei. Coll., 1880 Louisburg

Munroe, W. A., Univ. of Md., 1886 Moore County

McClure, Samuel C, Jeff. Med. Coll., 1878 Statesville

McCullers, J. J, L., Coll. P. & S., Balto., 1886 Raleigh

McKimmon, Archie, Univ. of Md., 1886 Robeson County

McLaughlin, John E., Univ. of Md., 1880 Statesville

Powell, James H., Coll. P. & S., Balto., 1880 Greene County

Pope, M. T. (col.) Leonard Med. Coll., 1886 Northampton County

Phillips, Theo. J., Coll. P, & S., Balto., 1886 Stokes County

Petrie, A. L., Coll. P. & S., Balto., 1880 Forsyth County

Ramseur, Geo. A., Jeff". Med. Coll., 1880 Catawba County

Riddick, Ivy G., Bellevue Med. Coll., 1886 Wake County

Rogers, James Rufus, Coll. P. & S., Balto., 1886 Wake County

Scruggs, L. A. (col.), Leonard Med. Coll., 1880 Liberty

Tate, Robt. W., Long Island Med. Coll., 1879 Duplin County

Ward, Wm, H., Univ. of Md., 1881 Plymouth

Woodley, Chas, P„ Bellevue Med. Coll., 1880 Kinston

Wynne, Thos. P., Univ. of Md., 1880 Warren County

N. C. MEDICAL SOCIETY. 911

'Name and College of Graduation. Address at Time Licensed.

Wilson Wm. E., Louisville Med. Coll., 188G Davidson

Williams, John T. (col.), Leonard Med. Coll., 1886 Charlotte

Young, L. B., Coll. P. & S., Balto., 1886 Wake County

ZoUicoffer, D. B., Coll. P. & S., Balto., 1881 Northampton County

26th session— May, 1887, Chailotte.

(Members of Board present: Drs. W. R. Wood, W. J. H. Bellamy,
A. W. Knox, P. L. Murphy, J. A. Eeagan, Frank Duffy and Willis
Alston. )

Abernathy, Henry L., Louisville Med. Coll., 1886 Hickory

Austin, James A., Jeff. Med. Coll., 1887 Union County

Ashcraft, John E., Univ. of N. Y., 1887 Monroe

Belk, Jolm M., Univ. of N. Y., 1887 Monroe

Byers, J. Wellington, Atlanta Med. Coll., 1882 Charlotte

Clark, Whipple W., Jeff. Med. Coll., 1886 Buncombe County

Capeliart, Alanson, Bellevue Med. Coll., 1887 Bertie County

Davidson, Wm. L., Univ. of Md., 1887 Mecklenburg County

Daniel, Starke S., Univ. of Md., 1887 Hertford County

Doak, James S., Univ. of N. Y., 1887 Rockingham County

Fearington, J. P., Univ. of Md., 1887 Chatham County

Fields, Adolphus, Jeff. Med. Coll., 1887 Kinston

Garrett, Frank J., 1 course, Univ. Md., 1887 Rockingliam County

Gibbon, Robt. L., Jeff. Med. Coll., 1887 Chai lotte

Goodwin, A. W., Bellevue Med. Coll., 1887 Raleigh

Grady, James C, Univ. of Balto., 1887 Wayne County

Henderson, Wm. B., Univ. of Md., 1887 Mecklenburg County

Hoover, Andrew J., Jeff. Med. Coll., 1887 Lincolnton

Hodge, Richard D., Coll. P. & S.. Balto., 1887 Raleigh

Jones, Amos Fielding, Coll. P. & S., Balto., 1885 Wilkesboro

Jones, Hiram C, 1 course. Coll. P. & S., Balto., 1886 Wilkes County

Justice, John C. B., Univ. of N. Y., 1886 Leicester

King, Ogden D., Long Island Hosp. Coll. Med., 1887 Wilmington

McAnally, Charles B., Univ. of N. Y., 1887 Rockingham County

McDuffie, James H., Univ. of Md., 1887 Moore County

Neal, John W., Univ. of N. Y., 1884 Stokes County

Pemberton, Wm. D., Univ. of Md., 1887 Stanly County

Ray, John L., Coll. P. & S., Balto., 1887 Burnsville

Shields, Henry B., Atlanta Med. Coll., 1887 Moore County

Stanton, David A., Vanderbilt University, 1887 Randolph County

Strickland, Ed. F.. Univ. of N. Y., 1887 Forsyth County

Winchester, Frank M., Jeff. Med. Coll., 1883 Monroe

Winborne, Robt. W., Univ. of Md., 1887 Chowan County

Williams, Buxton B., Univ. of Md., 1883 VVarrenton

912 APPENDIX.

27th session— May, 1888, Fayetteville.

(Members present: Drs. W. R. Wood, Francis Duffy, A. W. Knox,
J. A. Reagan, P. L. Murphy, Willis Alston and W. J. H. Bellamy.)

Name and College of Graduation. Address at Time Licensed.

*Alexander, Henry Q., Univ. of Md., 1887 Mecklenburg County

Brantley, Hassell, Univ. of Md., 1888 Stanhope

Cox, B. T., Univ. of Md., 1888 Greenville

Cheatham, Archibald, Univ. of Md., 1888 Henderson

Cherry, Wm. F., Univ. of Md., 1887 Tarboro

Chenault, Wm. F., Univ. of Md., 1888 Catawba

Caveness, J. W., Jeff. Med. Coll., 1888 Greensboro

Duffy, Leinster, 1 course. Coll. P. & S., Balto., 1885 New Bern

Ferree, T. T., Coll. P. & S., Balto., 1887 Brown's Summit

Flow, L. S., Univ. of N. Y., 1888 Clear Creek

Farrier, Geo. B., Univ. of N. Y., 1888 Kenansville

Gattis, Robt. L., Univ. of Md., 1888 Bellevoir

Goelet, E. B., Univ. of La., 1888 Brevard

Hughes, Geo. R., Univ. of N. Y., 1888 Snow Hill

Harrison, A. S., Univ. of Md., 1888 Ringwood

Hilliard, Charles E., Jeff. Med. Coll., 1888 Asheville

Jenkins, John H., Ky. School Med., 1887 Dallas

Lott, Henry S., Univ. of Ga., 1884 Winston

Lucas, Giles, Coll. P. & S., Balto., 1887 Johnston County

Loftin, Preston B., Univ. of Md., 1888 Hookerton

Ledbetter, E. A., Univ. of Md., 1888 Jamestown

Lynn, Isaac M., Bellevue Med. Coll., 1888 Earpsboro

Martin, W. C, Coll. P. & S., Balto., 1888 East Bend

Merriwether, Frank T., Univ. of Louisville, 188G Asheville

Munns, L. A., Coll. P. & S., Balto., 1885 Smithfield

Morrill, J., Univ. of Md., 1888 Farmville

Moore, Aaron M. (eol.), Leonard Med. Coll., 1888 Rosindale

McCullers, Eugene H., Bellevue Med. Coll., 1888 Clayton

McGee, James W., Jr., Bellevue Med. Coll., 1888 Raleigh

Reynolds, R. A. (col.), Leonard Med. Coll., 1888 Murfreesboro

Rose, E. P., Coll. P. & S., Balto., 1888 Wade

Sherrill, J. G., Louisville Med. Coll., 1888 Salisbury

Stamps, Thomas, Univ. of Louisville, 1888 Milton

Travis, Elma (female), Univ. of Mich., 1883 Raleigh

Walker, Jesse 0., Vanderbilt Univ., 1888 Randleman

Wyche, C. D., Univ. of Md., 1888 Dabney

28Tn SESSION— April, 1889, Elizabeth City.

(Members of Board present: Drs. W. R. Wood, A. W. Knox, J. A.
Reagan, W. Alston, P. L. Murphy, F. Duffy and W. J. H. Bellamy.)

Anderson, Albert, Univ. of Va., 1888 Wilson

Benton, C. M., Jeff. Med. Coll., 1889 Newton Grove

* Highest grade.— N. C. Medical Journal, Vol. xxxill, p. 50.

N. C. MEDICAL SOCIETY. 913

Name and College of Graduation. Address at Time Licensed.

Battle, James P., Univ. of Md., 1888 Rocky Mount

Banks, Braxton, Jeff. Med. Coll., 1889 Banks P. O.

Cannaday, S. H., Univ. of Va., 1887 Wilton

Cox, E. L., Univ. of Md., 1889 Catherine Lake

*Cobb, Wm. H. H., Jr., Jeff. Med. Coll., 1889 Goldsboro

Denning, O. L., Univ. of Va Dunn.

Davis, John A., Univ. of Md., 1889 Tarboro.

Edgerton, H. K., Vanderbilt Univ., 1889 Kenly

Fitzgerald, J. V., Jeff. Med. Coll., 1889 Linwood

Frey, J. H., 1 course Univ. of Va., 1888 Greensboro

Graham, Wm. A., Coll. P. & S., N. Y., 1888 Charlotte

Hall, H. H. (col.) , Leonard Med. Coll., 1889 Salisbury

Haskins, T. J., Univ. of Va., 1886 Edenton

Highsmith, J. F., Jeff. Med. Coll., 1889 Hives P. 0.

Houston, E. Q., 1st course Univ. of Va., 1888 Mount Mourne

Hughes, W. H. (col.), Leonard Med. Coll., 1888 Greensboro

Jenkins, Jeff D., Univ. of N. Y., 1889 Tarboro

King, Edward S., Univ. of Md., 1889 Statesville

Mask, T. R. (col.), Leonard Med. Coll., 1889 Rockingham

Marsh, J. H., Jeff. Med. Coll., 1889 Gray's Creek

Michaux, E. R., Univ. of N. Y., 1889 Greensboro

McAden, G. M., Univ. of Md., 1889 Charlotte

McMullan, Thos. Shelton, Univ. Va., 1888, Univ. N. Y., 1889, Hertford

Nicholson, W. H., Univ. of Md., 1889 Franklinton

Nicholson, P. A., Coll. P. & S., Balto., 1889 Washington

Ross, C. E., Univ. of Md., 1889 Charlotte

Ross, W. F., Univ. of N. Y Hot Springs

Richardson, W. J., Jeff. Med. Coll., 1889 Greensboro

Renn, Geo. A., Univ. of N. Y., 1889 Raleigh

Stokes, W. F., Louisville Med. Coll., 1888 Magnolia

Starnes, E. C, Jeff. Med. Coll., 1888 Asheville

Sutton, W. G., Jeff. Med. Coll., 1889 Seven Springs

Sugg, Edgar H., Univ. of N. Y., 1889 Snow Hill

Strong, Chas. M., Univ. of Md., 1881 Charlotte

Strickland, M. C, Jeff. Med. Coll., 1889 Bliss

Thacker, J. H., Med.-Chirurg., Pa., 1889 Reidsville

Tayloe, J. W., Univ. of Va., 1888 Union

Vines, W. W., Univ. of Md., 1889 Tarboro

Ward, J. M., Bellevue Med. Coll., 1889 Moyton

Wliite, John W., Jeff. Med. Coll., 1889 Wilkesboro

White, Geo. I., Univ. of Va., 1888 Jefferson

Whitehead, Richard H., Univ. of Va., 1888 Charlottesville, Va.

Wynn, A. L., Univ. of Md., 1889 Ridgeway

*Made highest grade.— N. C. Medical Journal, Vol. xxxlii, p. 50.

914 APPENDIX.

29th session— May, 1890, Oxford.

(Members present, Drs. W. R. Wood, A. W. Knox, P. L. Murphy,
F. Duflfy, J. A. Reagan, and W. J. H. Bellamy.)

'Name and College of Graduation. Address at Time Licensed.

Alston, M. W. (col.), Leonard Med. Coll., 1890 Louisburg

Ambler, Chase P., West. Reserve Univ., 0., 1889 Asheville

Blaylock, N. M., Coll. P. & S., Balto., 1890 Boucks

Blue, Kenneth A., Univ. of Md., 1890 Hasty

Bynum, James T., Coll. P. & S., Balto., 1890 Gerraantown

Bradsher, Jesse C, Univ. of K Y., 1887 Olive Hill

Bowling, Edward H., 1st course Coll. P. & S., Balto., 1889 Luster

Caldwell, D. (col.), Leonard Med. Col., 1890 Chapel Hill

Consts, Daniel W., Tulane Univ. of La., 1890 Reidsville

Flynt, S. S., Coll. P. & S., Balto., 1889 Rural Hall

Gaddy, John A., Univ. of Md., 1890 Cedar Hill

Hargrove, Chas. B., Univ. of Md., 1890 Tarboro

Headen, Wm. E., 1st course Univ. of Md., 1889 Pittsboro

Hinman, Richard E., N. Y. Homeop. Med. Coll., 1888 Charlotte

Hubbard, Chas. E., Jeff. Med. Coll., 1888 Wilkesboro

Horah, Alston D., Univ. of Va., 1889 Salisbury

Hughler, G. W., Jr., Jeff. Med. Coll., 1885 Washington

Jenkins, C. L., Univ. of N. Y., 1890 . .Tarboro

Jewett, Robert D., Univ. of Va., 1888 Wilmington

Jerome, James R., Univ. of Md., 1890 Mint Hill

Mack, Alexander, So. Car. Med. Coll., 1890 Red Springs

Mayo, Wm. R., Univ. of Md., 1890 Bethel

Mewborn, Geo. T., Univ. of Md., 1889 Snow Hill

Melcher, Paul N. (col.), Leonard Med. Coll., 1890 Concord

McAllister, Wm., Coll. P. & S., Balto., 1890 Milledgeville

Nichols, Rhodes E., Med. Coll. of Va., 1890 Dayton

Norfleet, Leon E., Coll. P. & S., N. Y., 1889 Tarboro

Nelson, Robt. J., Louisville Med. Coll., 1890 Bethel

Peacock, John J., Univ. of Md., 1890 Saratoga

*Primrose, Robert S., Bellevue Med. Coll., 1890 New Bern

Reid, Robert M., Univ. of N. Y., 1890 Steel Creek

Ross, Robt. D., Univ. of N. Y., 1890 Charlotte

Sanderford, John F., Coll. P. & S., Balto., 1890 Creedmore

Sawyer, L. L., Univ. of Md., 1890 Elizabeth City

Shamburger, John B., Univ. of Md., 1890 Asbury

Spicer, John, Bellevue Med. Coll., 1889 .Goldsboro

Sexton, C. H., Univ. of Md., 1890 Raleigh

Strickland, John T., Univ. of Md., 1890 Castalia

Teague, Rufus J., Univ. of Md., 1890 Alpha

Vann, Luther L., Jeff. Med. Coll., 1890 Winston

Watts, J. B., Coll. P. & S., Balto., 1890 Taylorsville

Watson, Duncan I., Univ. of Louisville, Ky., 1890 Southport

* Made highest grade.— N. 0. Medical Journal, Vol. xxxiii, p. 51.

i\. C. MEDICAL SOCIETY. 915

Williamson, James C, Univ. of Md., 1890

Windsor, Wm. S., Univ. of Md., 1890 Yadkin County

Whitley, Daniel P., Univ. of Md., 1889 Big Lick

30th session— May, 1891, Asheville.

(Members present, Drs. W. H. Whitehead, Geo. W. Long, R. S. Young,
R. L. Payne, Jr., Geo. W. Purefoy, Geo. G. Thomas and L. J. Picot.)

Name and College of Graduation. Address at Time Licensed.

Atkinson, W. H., Georgetown Univ., D. C Washington, D. C.

Bryant, R. H. (col.), Leonard Med. Coll Asheville

Bryan, J. J., Univ. of Md Battleboro

'Bellamy, Russell, 1st course Univ. of N. Y Wilmington

Burleyson, L. N., Univ. of Md Flows

Browning, R. Ray, Univ. of Md Littleton

Carlton, J. F., Univ. of N. Y Statesville

Campbell, A., Univ. of Md Snow Hill

Corrilver, C. W., Jeff. Med. Coll China Grove

Cheesborough, Thos. Patton, Univ. of N. Y Asheville

Davis, J. J., Univ. of Md Woodville

Fitch, W. E., Univ. of N. Y McRay

Foil, M. A., Jeff. Med. Coll., 1891 Mt. Pleasant

Foster, G. A., Balto. Med. Coll Oakdale

Gouger, Geo. J., 2d course Univ. of Md Mt. Mourne

Gilmer, C. S., Univ. of N. Y Greensboro

Gibbon, John H., Jeff. Med. Coll Charlotte

Goodman, E. G., Univ. of Md El Paso

Gordon, James R., Univ. of N. Y Friendship

Hackler, G. M., Univ. of Md Mars Hill

Herman, F. L., nongraduate 1st course Conover's

Hill, W. J., Univ. of Md Statesville

Houck, Albert F., P. & S., Balto Lenoir

High, L. F., P. & S., Balto Thomas

Jones, C. D., Vanderbilt University Lewisville

Jordan, G. E., P. & S., Balto Altamaha

Jordan, Chas. S., Univ. of N. Y Asheville

Julian, Chas. A., Louisville Med. Coll Thomasville

Lefree, Robt. F. L., Univ. of Md Mt. Pleasant

Matherson, R. C, P. & S., Balto Taylorsville

Marshall, John S., Miami Med. Coll Asheville

Millender, M. C, Univ. of Va., 1887 Pigeon River

Misseldine, O. S., So. Car. Med. Coll Tryon

Montgomery, John C, Univ. of N. Y Concord

Moore, N. G iHuntersville

Matthews, Thos. A., Univ. of Md Battleboro

Martin, W. J., Univ. of Va Davidson

McBrayer, Lewis B., Louisville Med. Coll Asheville

* Made highest grade.

916 APPENDIX.

Name and College of Chaduation. Address at Time Licensed.

Reeves, Everett, P. & S., Balto Dresden

Reid, W. R., Univ. of N. Y Griffith

Reid, T. N., Univ. of N. Y Griffith

Sane, John W., Louisville Med. Coll Gastonia

Sloan, J. M., Louisville Med. Coll Charlotte

Steele, W. C, Univ. of Md Croft

Spencer, Wni. O., Jeff. Med. Coll Moeksville

Thompson, Robert, nongraduate P. & S., Balto Sparta

Wakefield, Wm. H., Hosp. Coll. Med., Ky Greensboro

Walker, Chas. E., Univ. of Md Huntersville

Wheeler, J. R., P. & S., Balto Spring Hope

3 1st session— May, 1892, Wilmington.

(Members present, Drs. W. H. Whitehead, Geo. G. Thomas, R. L.
Payne, Jr., Geo. W. Long, R. S. Young, G. W. Purefoy and L. J. Picot.)

Adams, Claude A., Coll. P. & S., Balto., 1892 Cary

Ashworth, W. C, Coll. P. & S., Balto., 1892 Asheboro

Baird, Harry L., Vanderbilt Univ Asheville

Ballou, Wm. R., Bellevue Med. Coll Asheville

Boaz, T. A., P. & S., Balto., 1892 Price

*Buchanan, E. J., Univ. of Md., 1892 Salisbury

Bowen, Wm., McGill University Knoxville, Tenn.

Blount, J. G., Bellevue Med. Coll., 1892 Washington

Bennett, John H., Univ. of N. Y., 1892 Wadesboro

Bullock, W. B., Bellevue Med. Coll Franklinton

Bynum, John, Univ. of N. Y., 1892 Winston

Crowell, L. A., Balto. Med. Coll Lincolnton

Crowell, A. J., nongrad. Univ. of Md Cabarrus Store

Caviness, R. L., Balto. Univ Coleridge

Costen, J. W., P. & S., Balto., 1892 Sunbury

Dellenger, J. E. (col.), Leonard Med. Coll Lowesville

Folger, W. C, Hosp. Coll. Med., Ky Dodson

Gattis, M. E., P. & S., Balto Raleigh

Griggs, J. B., Univ. of Md., 1892 Elizabeth City

Hauser, N. B. (col.), Leonard Med. Coll Charlotte

Harris, A. H., nongrad. Med.-Chi., Phila., 1892 Wilmington

Hoover, H. R., Balto. Med. Coll Elm City

Jones, J. W. (col.), Leonard Med. Coll Warrenton

Jones, C. M., Univ. of Md., 1892 Tarboro

Koontz, A. J., Coll. P. & S., Balto., 1887 Roaring River

Long, Henry F., Balto. Med. Coll., 1891 Statesville

Martin, S. L., Balto. Med. Coll Leaksville

McGilvra, S. C, Univ. of Va., 1890 Asheville

Oliveros, C. J., Univ. of Md., 1889 Asheville

* Made highest grade.

X. C. MEDICAL SOCIETY, 917

Name and College of Graduation. Address at Time Licensed.

Perkins, S. L., Balto. Med. 'Coll., 1891 Solitude

Pennington, S. E., Coll. P. & S., Balto., 1891 Sturgills

Rodman, John C, Bellevue Med. Coll., 1892 Washington

Roberts, Frank, Jeff. Med. Coll., 1892 Marshall

Rieves, J. T., Louisville Med. Coll., 1891 Julian

Rainey, E. A., Ky. School Med Germantown

Roberson, L. V., Jeff. Med. Coll., 1891 Weaverville

Staneill, R. H., Jr., Univ. of Md Margarettsville

Stevens, M. L., Balto. Med. Coll., 1891 Enochsville

Summers, Chas. L., Univ. of Md., 1887 Winston

Smith, R. W., Univ. of Md., 1887 Hertford

Tayloe, Joshua, Bellevue Med. Coll Washington

Thomas, H. J., Rush Med. Coll Winston

Twitty, John C, Balto. Med. Coll., 1892 Rutherfordton

Williams, Harry S., Medico-Chirurg., Pa Asheville

Wright, J. Thomas, Coll. P. & S., Balto., 1892 Salisbury

32d SESSION— May, 1893, Raleigh.

(Members present, Drs. W. H. Whitehead, L. J. Picot, Geo. G. Thomas,
R, S. Young, Geo. W. Long, H. B. Weaver and J. M. Baker.)

Abel, J. F., Balto. Univ Canton

Anderson, C. A., nongraduate P. & S., Balto Stainback

Arvie, G. F., Ky. School Med Ritchie's Mills

Averitt, K. G., Balto. Med. Coll Steadman

Beckwith, W. G., P. & S., Balto New Hill

Bowen, W. D., P. & S., Balto Plymouth

Corbell, E. F., Univ. of Md Sunbury

Grumpier, E. L., Med. Coll. Va Hansoms, Va.

Dixon, Joseph, nongrad. Med. Coll. of Va Fountain Hill

Dugoid, Joseph W., Univ. of Md New Bern

Faison, W. F., Univ. of Va Fayetteville

Faucette, T. S., Balto. Med. Coll Burlington

Griffin, C. F., P. & S., Balto Woodland

Harper, Chas. T., nongrad. N. C. Med. Coll Wilmington

Hathcock, T. A., Univ. of Md Norwood

Hill, W. Lee, P. & S., Balto Walnut Cove

*Holloway, R. L., Med. Coll. of Va Fish Dam

Ivie, Geo. N., Balto. Med. Coll Statesville

Kernodle, J. L., Coll. P. & S., Balto Elon College

Laughinghouse, Chas. J. O'H., Univ. of Pa Greenville

Long, LeRoy, Louisville Med. Coll Lowesville

Morris, Jos. A., Vanderbilt Univ Wilton

Moore, W. B., Balto. Med. Coll Francisco

Moore, W. J., Coll. P. & S., Balto Sandy Ridge

Mosely, Chas. W., Coll. P. & S., Balto Lewisville

* Made highest grade.

918

APPENDIX.

'Name and College of Graduation. Address at Time Licensed.

McKenzie, W. W., Jeff. Med. Coll Salisbury

McNairy, C. B., P. & S., Balto Lomont

Norment, W. B., Univ. of Md Lumberton

Norment, T. A., nongrad. N. C. Med. Coll Lumberton

Phillips, C. H., Balto. Univ Fuller's

Pope, H. T., nongrad. N. C. Med. Coll Lumberton

Rheim, J. F., Bellevue Med. Coll Xew Bern

Riddick, Thos. M., P. & S., Balto Elizabeth City

Russell, Frank H., Univ. of Md Wilmington

Sapp, L. L., Jeff. Med. Coll Kernersville

Smith, G. A., Louisville Med. Coll Siler City

Street, M. E., P. & S., Balto Fairhaven

Stevenson, F. F., Louisville Med. Coll Statesville

Ward, N. G., Jeff. Med. Coll Belvidere

Whitehead, F. W., Coll. P. & S., Balto Scotland Neck

Whisnant, A. M., P. & S., Balto Shelby

Walton, C, B., P. & S., Balto Raleigh

Wright, S. P. (col.), Leonard Med. Coll Elizabethton

Winley, C. T., P. & S., Balto Yeatesville

Woodell, B. C, Balto. Med. Coll Scottsville

Williams, R. J., Jeff. Med. Coll Bannerman

Wyche, Chas. T., P. & S., Balto Oxford

32d session (Adjourned)— August, 1893, Wrightsville.

Ashworth, B. L., Coll. P. & S., Balto Fairview

Dees, W. A., Univ. of Ga Monroe

Doughton, J. L., Coll. P. & S., Balto Sparta

Hill, D. J., Coll. P. & S., Balto Germantown

Jones, W. J., Jr., Univ. of N. Y Goldsboro

Jackson, C. C, Coll. P. & S., Balto Plymouth

Lassiter, W. L. ( col. ) , Howard Univ Seaboard

Mease, J. Herbert, Vanderbilt Univ Canton

McCracken, J. F., Coll. P. & S., Balto Guilford College

McCandless, W. L., Univ. of N. Y Danbury

McGougan, J. V., Univ. of Md Lumber Bridge

Rowland, D. S., Balto. Med. Coll Henderson

Smith, L. C, Balto. Med. Coll Polkton

Swett, W. P., Univ. of Vermont Southern Pines

Warren, Wm. E., nongrad. Univ. of N. Y ] . . . Greenville

WHiarton, L. D., Tulane Univ. of La Greensboro

33d SESSION— May, 1894, Greensboro.

(Members of Board present: Drs. W. H. Whitehead, L. J. Picot, R. S.
Y^'oung, J. M. Baker, H. B. Weaver and Geo. W. Long.)

Abernethy, H. N., Louisville Med. Coll., 1894 Mariposa

Alexander, J. R., Univ. of Md., 1894 Croft

INT. C. MEDICAL SOCIETY. 919

Name and College of Graduation. Address at Time Licensed.

Alston, J. H. (col.), Leonard Med. Coll., 1894 Wilmington

Bennett, Jos. H., Univ. of Md., 1894 Wadesboro

Brown, J. S., Northwest Univ., 111., 1893 Bear Poplar

Bowman, H. P., Univ. of Tenn Liberty

Brown, L. H. (col. female). Woman's Med. Coll., Pa., 1894, Wilmington

Brantley, C. H., Coll. P. & S., Balto, 1887 Frick

Bryan, J. W. (col.), Leonard Med. Coll., 1894 Tarboro

Clark, F. M., Coll. P. & S., Balto Beaufort

Coggeshall, J. A., Bellevue Med. Coll., 1879 Oxford

Davis, Francis M., Vanderbilt Univ., 1894 Iron Duff

Evans, W. E., Med. Coll. of Va., 1894 Carthage

Gill, James N., Vanderbilt Univ Weaverville

Greenwood, B. H., Balto. Med. Coll., 1893 Barnardsville

Gore, Anna M. (female), Woman's Med. Coll., N. Y. Inf Greensboro

Hays, Benj. K., Univ. Coll. Med., Va., 1894 Oxford

Henderson, S. McD., Univ. of Md Croft

Jefferson, E. R. (col.), Leonard Med. Coll., 1894 Raleigh

Jones, Clara E. (female), Woman's Med. Coll., Pa., 1894 Goldsboro

Kornegay, J. W., P. & S., Balto., 1893 Mt. Olive

Kirkpatrick, Wm. L., Vanderbilt Univ., 1894 Crabtree

Ledbetter, J. M., Vanderbilt Univ., 1894 Rockingham

Linn, T. E., Pulte Med. Coll. (Homeop.) , 1888 Asheville

Miller, J. T., Univ. of Va., 1892 Hot Springs

Menzies, H. C, N. C. Med. Coll., 1894 Hickory

Mott, S. W., X. C, Med. Coll., 1894 Davidson

McGeachy, R. S., Bellevue Med. Coll., 1894 Fayetteville

Korvell, L. A., Univ. of Md., 1894 ". Coleraine

Palmer, J. R., Atlanta Med. Coll., 1894 Macon

Pickett, John A., Univ. of Tenn., 1894 Liberty

Reid, Geo. P., Univ. Coll. Med., Va Old Fort

*Royster, Hubert Ashley, Univ. of Pa., 1894 Raleigh

Sumner, W. J., Univ. of Tenn., 1893 Buffalo Ford

Smoot, J. E., Balto. Med. Coll., 1893 Omega

Thrash, Geo., Chattanooga Med. Coll., 1892 Asheville

Tennent, Gaillard S., N. C. Med. Coll., 1894 Asheville

Thames, John, Louisville Med. Coll., 1894 Greensboro

Turlington, W. T., P. & S., Balto., 1894 Benson

Utley, H. G., Univ. of Md., 1894 Raleigh

Woodcock, S. J., Hosp. Coll. Med., Ky Asheville

Wooten, W. H., N. C. Med. Coll., 1894 Davidson

Young, W. D., P. & S., Balto., 1889 East Durham

33d SESSION (Adjourned)— July, 1894, Morehead City.

Arthur, T. H., Coll. P. & S., Balto., 1894 Harrell's Store

Atkins, G. T., N. C. Med. Coll., 1894 Thomasville

* Made highest grade.

020 APPENDIX.

2Vome and College of Graduation. Address at Time Licensed.

Crocker, S. H., Ky. School Med., 1893 Garner

Hord, J. G., Univ. of Louisville, 1891 Kings Mountain

McCoy, E. M., N. C. Med. Coll., 1894 Bristow

Price, J. H., Coll. P. & S., Balto., 1894 Price's Mills

*Smith\vick, J. W. P., Univ. of Md., 1894 Merry Hill

Robb, Isaac, Pulte Med. Coll. (Homeop.) Asheville

Woodcock, John H., Hosp. Coll. Med., Ky Asheville

34th session— May, 1895, Goldsboro.

(Members present: Drs. W. H. Whitehead, L. J. Picot, J. M. Hays,
J. M. Baker, H. B. Weaver, Geo. W. Long, and T. S. Burbank.)

Alston, J. H., Vanderbilt Univ., 1894 Richmond, Va.

Aydlett, H. T., Univ. of Va., 1894 Elizabeth City

Anderson, Jasper K, Univ. of Md., 1895 Albemarle

Brevard, E. M., Univ. of Md Charlotte

Blair, M. P., Med. Coll. of Va., 1895 Wadesboro

Brooks, E. H., Balto. Med. Coll., 1894 Monroeton

Bowen, M. D. (col.), Leonard Med. Coll., 1895 Clarkton

Bullock, J. L. (col.), Meharry Med. Coll., 1895 Greensboro

Cheatham, Goode, N. C. Med. Coll., 1895 Henderson

Crowell, S. M., Univ. of Md., 1895 Mint Hill

Crowell, W. H., Univ. of Md., 1895 Portsmouth

*Cohen, Lee, Univ. of Md., 1895 New Bern

Crim, F. D., Coll. P. & S., N. Y., 1881 Hot Springs

Daniel, N. C, N. C. Med. Coll., 1895 Satterthwaite

Dickinson, E. T., Med. Coll. of Va Fremont

Eller, A. J., Coll. P. & S., Balto., 1893 Reedy Branch

Frazier, L. G., Univ. of Md., 1895 Henderson

Foutz, J. H., Vanderbilt Univ., 1895 Franklin

Gibson, T. C, Univ. of Georgetown, D. C, 1893 Winton

Gibbs, N. M., nongrad. N. C. Med. Coll Fairfield

Grady, Earl, Univ. of Md., 1894 Fairfield

Goode, T. v., Ky. School of Med Cherryville

Hay, W. S., Univ. of Ga., 1890 Clover, S. C.

Hamrick, J. C, P. & S., Balto., 1895 Henrietta

Halsey, Benj. F., Vanderbilt Univ., 1893 Roper

Holmes, F. H., Univ. of Md., 1895 Clinton

Hood, G. A., P. & S., Balto., 1895 Newton Grove

Jones, W. S., nongraduate N. C. Med. Coll Goldsboro

Johnson, D. J., Univ. of Tenn., 1895 Fork Creek

Klebs, Edwin, University of Berlin, 1857 Asheville

Kenan, O. H., Coll. P. & S., Balto., 1894 Kenansville

Minor, Chas. L., Univ. of Va., 1888 Asheville

Morehead, R. P., P. & S., Balto., 1895 Lasker

McCoy, C. E., Vanderbilt Univ., 1895 Franklin

* Made highest grade.

X. C. MEDICAL SOCIETY. 921

Name and College of Graduation. Addt-ess at Time Licensed.

Nelon, M. Olivia (female). Woman's Med. Coll., 0 Asheville

Pressly, Geo. W., Jeff. Med. Coll., 1892 Charlotte

Potts, F. L., nongrad. Univ. of Ga Washington

Parrott, James M., Tulane Univ. of La Kinston

Eeitzel, J. R., Univ. of Tenn., 1892 Pineville

Reynolds, Carl V., Univ. of N. Y., 1895 Asheville

Russell, E. Reid, Univ. of Md., 1895 Rockingham

Rodwell, J. W., Coll. P. & S., Balto Macon

Siler, F. L., nongrad. Vanderbilt Univ Dillsboro

Stamey, E. L., Atlanta Med. Coll., 1895 Morehead

Shaw, W. G., P. & S., Balto., 1892 Fortcol

Spruill, J. L., Univ. of Md., 1895 Columbia

Thompson, A. F., Med. Coll! Indiana, 1895 Wadeville

Thompson, X. A., nongrad. N. C. Med. Coll Lumberton

Turlington, R. S., Med. Coll. of Va., 1895 Bennettsville, S. C.

Walker, T. C, Med. Coll. of Va Randleman

Warren, S. L. (col.), Leonard Med. Coll., 1895 Durham

Whittington, W. W., Louisville Med. Coll., 1895 Asheville

Williams, J. V., Univ. of Md., 1889 Evaline

34th session (Adjourned)— August, 1895, Wrightsville.

Bernhardt, C. H., Jeff. Med. Coll., 1895 Mt. Pleasant

Costen, H. W., Univ. of Va., 1895 Fairfield

Fuller, W. T. (col.), Leonard Med. Coll., 1895 Reidsville

*Graham, B. R., Univ. of Va., 1895 Wallace

Hartsell, F. E., Balto. Med. Coll., 1895 Concord

Hilliard, Walter L., Jeff. Med. Coll., 1895 Asheville

Holt, W. P., Jeff. Med. Coll., 1895 Willardsville

Millard, J. P., Med. Coll. of S. C, 1895 Asheville

Mann. S. M., P. & S., Balto, 1895 Manteo

*Moye, E. A., Univ. of Va., 1895 Greenville

McCampbell, John, Balto. Med. Coll., 1894 Morganton

Sawyer, C. J., P. & S., Balto., 1895 Belle Cross

Sevier, Daniel E., Jeff. Med. Coll., 1895 Asheville

Sevier, Joseph T., Jeff. Med. Coll., 1895 Asheville

35th SESSION— May, 1896, Winston.

(Members of Board present: Drs. W. H. Whitehead, L. J. Picot, H. B.
Weaver, J. M. Hays, and Geo. W. Long.)

Aaron, L. P., nongrad. Univ. of Md Mt. Olive

Ardrey, L. L., Bellevue Med. Coll Charlotte

Bennett, E. M., Vanderbilt University Palm

Blackburn, T. C, Balto. Med. Coll Boone

Brown, Ed. M., Bellevue Med. Coll Washington

Burt, S. P., Coll. P. & S., Balto Centerville

* Made highest grade— a tie.

922 APPENDIX.

'Name and College of Graduation. Address at Time Licensed.

Byerly, A. B., Univ. Coll. Med., Va Yadkin College

Browning, E. S., nongrad. N. C. Med. Coll Pleasant Grove

Crocker, W. D., Louisville Med. Coll Lueama

Davis, A. P., Ky. School of Med Daisy

Fearing, Isaiah, Coll. P. & S., Balto Elizabeth City

Griffin, E. M., nongrad. Univ. of Va Winston

Griggs, W. T., Univ. of Va Hai binger

Gilbert, J. C, nongrad. Med. Coll. of Va Hope Mills

Garrison, D. A., Louisville Med. Coll Bessemer City

Glenn, Eugene B., Jeff. Med. Coll Asheville

Heard, E. N., Miami Med. Coll., O Asheville

Hutchins, E. M., N. C. Med. Coll Capp's Mills

Hoyle, Hughes B., N. C. Med. Coll " Jonesboro

Horton, W. P., Balto. Med. Coll North Wilkesboro

Horton, W. C, Coll. P. & S., Balto Wakefield

Hemphill, W. E., Balto. Med. Coll Archer's

Harzlip, J. H., Coll. P. & S., Balto Salem Chapel

Hauser, B. B., nongrad. P. & S., Balto Yadkinville

Hamlen, H. C, Univ. Coll. Med., Va Winston

Harris, Joy (female). Woman's Med. Coll., Balto Summerfield

Koonce, S. E., Coll. P. & S., Balto Newton

Kirby, Guy S., nongrad. N. C. Med. Coll Lenoir

Leister, E. W., Med. Coll. of Va Elizabeth City

Leak, J. J., nongrad. Univ. of Md Francisco

Leister, J. L., Med. Coll. of Va Elizabeth City

Lattimore, E. B., nongrad. N. C. Med. Coll Shelby

Medford, Samuel B., University of Nashville Clyde

Morris, E. R., Louisville Med. Coll Asheville

Moser, D. M., nongrad. N. C. Med. Coll Conovers

Massey, John S. ( col. ) , Leonard Med. Coll Monroe

Mopp, Wm. E,. (col.), Leonard Med. Coll Raleigh

Matthews, J. B., Med. Coll. of Va Durham

Mitchell, W., Univ. of Md., 1895 Lewiston

*Mangum, Chas. S., Jeff. Med. Coll Chapel Hill

McAnally, W. J., nongrad. Univ. Med. Coll., Va Madison

McCracken, C. M., nongrad. N. C. Med. Coll Clyde

McLeod, A. H., Balto. Med. Coll Keyser

McLaughlin, C. S., Univ. of Md Newels

Norman, Geo. W., Balto. Med. Coll Reidsville

Osborne, John M., Jeff. Med. Coll Asheville

Purlear, C. J., Vanderbilt Univ Boone

Pearson, Edward J., Jeff. Med. Coll Asheville

Royster, S. S., Tenn. Med. Coll Mooresboro

Ricks, S. E., Med. Coll. of Va Pantego

Swann, J. F., Coll. P. & S., Balto Cool Spring

* Made highest grade.

. N. C. MEDICAL SOCIETY. 923

'Name and College of Graduation. Address at Time Licensed.

Shepherd, J. M., Balto. Med. Coll Campbell

Tate, Chas. S., Balto. Med. Coll Ramseiir

Upchurch, H. C, Coll. P. & S., N. Y Raleigh

Williams, Geo. W. (col.), Leonard Med. Coll Ealeigh

Wilson, F. G., Univ. of Md Gastonia

Watkins, Thos. I., nongrad. P. & S., Balto Walnut Cove

Withers, Banks, Univ. of Md Davidson

Young, James, nongrad. N. C. Med. Coll Mooresville

Young, J. J., nongrad. P. & S., Balto Smithfield

35th session (Adjourned)— August, 1896, Morehead City.

Chapman, H. J., Univ. of Pa., 1895 Asheville

Davis, Geo., Ky. School of Med., 1894 Beaufort

Fort, James E. (col.), Leonard Med. Coll., 1896 Eureka

*Lee, R. E., Univ. of Md., 1896 Clinton

Lloyd, J. M. (col.), Leonard Med. Coll., 1896 ; . . .Elizabethton

Monk, H. G., Med. Coll. of Va., 1896 Newton Grove

Tayloe, Armistead K., nongrad. Univ. Med. Coll., va Washington

36th SESSION— June, 1897, Morehead City.

(Members of Board present: Drs. J. M. Baker, H. B. Weaver, T. S.
Burbank, D. T. Tayloe, Thos. Eli Anderson, R. H. Whitehead, and K. P.
Battle, Jr.)

Bell, A. E., Univ. of Md Charlotte

Betts, Henry T., Univ. of Md Baltimore, Md.

Bitting, B. T., Balto. Med. Coll Mizpah

Bonner, H. M., Med. Coll. of Va Aurora

Bethune, A. C, Univ. of Va Aberdeen

Birting, R. Clinton, nongraduate Wilmington

Brown, G. A., Univ. Coll. of Med. Va Bear Poplar

Brooks, Jos. E., Univ. Coll. Med., Va Siler City

Barrett, W. W., Ky. School of Med ]\Ionroe

Campbell, Reuben A., nongraduate Statesville

David, J. E., Univ. of Pa ' Asheville

Davis, J. Caesar, nongrad. N. C. Med. Coll Iron Duff

Dawson, W. W., Univ. of Md Grifton

Everett, A. C, Univ. of Md Louisburg

Flippen, R. E. L., Balto. Med. Coll Pilot Mountain

Glenn, L. N., Univ. of Md Crowder's Creek

Garren, G. A. (col.), Leonard Med. Coll Greensboro

Goodman, A. B., N. C. Med. Coll Sanders

Harrell, S. N., Univ. of Md Coakley

Hiden, James H., Va. Med. Coll Richmond, Va.

Hutton, Paul C, Columbia College Goldsboro

Hill, Wm. I., Univ. of Md Morgan's Mills

* Made highest grade.

1)24 APPENDIX.

'Name and College of Graduation. Address at Time Licensed.

Hunter, B. R., Louisville Med. Coll Kings Mountain

Hart, John Ellis, Univ. of Md Monroe

Hood, J. J. (col. ) , Leonard Med. Coll Fayetteviile

Holding, S. P., Bellevue Med. Coll Wake Forest

Hayes, L. 0., Univ. Coll. Med., Va Lacuna

John, Peter, Univ. oi Md Laurinburg

Justice, M. L., N. C. Med. Coll Peru

Judd, Jame3 M., Balto. Med. Coll Enno

Jones, Clarence P., Univ. Coll. Med., Va Rockingham

* Jones, R. Duval, Univ. of Md New Bern

Koonce, F. D., Jr Richlands

Kennedy, Geo. W Waycross

Kinsman, Henry F., Univ. of Vermont, 1894 Hamlet

Lee, L. V., Atlanta Med. Coll Lattimore

Lippett, W. H., Univ. of Md Pittsboro

Love, Stonewall J., Atlanta Med. Coll Long's Store

Matthews, J. 0., Univ. Coll. Med., Va Taylor's Bridge

Morrell, David S., Balto. Med. Coll Farmville

McGeachy, James S., N. C. Med. Coll N. C. Med. Coll.

McGinnis, R. H., Uhiv. Coll. Med., Va Baltimore, Md.

Northrup, Theodore L., Univ. of Md Laurinburg

Patterson, R. Delmore, Balto. Med. Coll Liberty

Person, J. B., Jr., Med. Coll. of \a Fremont

Powell, W. v., Univ. of Va Asheville

Pearson, Chas. L., Univ. of Md Asheville

Pierce, Sterling B., Bellevue Med. Coll Weldon

Paris, O. J., Balto. Med. Coll Gath

Roberson, Chas., Long Island Med. Coll Chapel Hill

Spicer, William, nongraduate Goldsboro

Savage, R. L., Univ. of Md Hobgood

Sawyer, James, Bellevue Med. Coll Asheville

Smithwick, James E., Univ. of Md Janesville

Wallis, W. J., Coll. P. & S., Balto , Brevard

Weaver, W. J., nongraduate Asheville

Wallace, J. Brown, Univ. of Md Sardis

Williams, Geo. D., Coll. P. & S., Balto Gatesville

Wharton, C. R., Med. Coll. of Va Ruffin

Webb, W. P., S. C. Med. Coll Rockingham

Wyche, Allen A. (col.), Leonard Med. Coll Henderson

Whitley, A. D. H., Univ. of Md Zoar

Zachaiy, R. E., nongraduate Chapel Hill

37th session— May, 1898, Charlotte.

(Members Board present: Drs. J. M. Baker, H. B. Weaver, T. E.
Anderson, D. T. Tayloe, K. P. Battle, Jr., and J. Howell Way.)

Boyette, E. C, Balto. Med. Coll., 1893 Mt. Holly

* Made highe.st grade.

N. c. :mei)ical society, 92c

Name and College of Graduation.. Address at Time Licenced.

*Brooks, W. H., Balto. Med. Coll., 1889 Greensboro

Biirrus, John T., Louisville Med. Coll., 1898 Hockford

Bynura, C. H. (col.), Leonard Med. Coll., 1896 Wilson

Campbell, J. I., nongraduate Mint Hill

Caton, G. A., Med. Coll. Va., 1898 Grantsboro

Darbonier, F. L., Long Island Med. Coll., 1897 Asheville

Davidson, John E. S., Univ. of Md., 1894 Triangle

Duncan, G. F., nongraduate Sparta

Denson, Eugene B., Univ. of Md., 1898 Ealeigh

Everington, Geo. D., nongraduate Louisburg

Flippen, R. D., Louisville Med. Coll., 1891 Pilot Mountain

Flippen, S. T., nongraduate Siloam

Gilreath, F. H., Univ. of Nashville, 1898 Moravian Falls

Graves, W. H. (col.), Leonard Med. Coll., 1898 Reidsville

Hunter, J. B., Univ. of Louisville, Ky., 1898 Nimrod

Haller, O. L., Balto. Med. Coll., 1892 Mt. Sterling

Highsniith, Chas., Balto. Med. Coll., 1898 Parkersburg

Jones, Walter J., nongraduate Outlaw's Bridge

Jenkins, R. E., Louisville Med. Coll., 1898 Belmont

Kerr, J. E., Univ. of Md., 1898 Pee Dee

Knight, W. P., Balto. Med. Coll., 1898 Oak Ridge

Long, Fred. Y., nongraduate Catawba

Lord, Alonzo D., Coll. P. & S., Boston, 1897 Statesville

Lee, Plato H., Univ. of Nashville, 1894 Alexander

Malloy, S. A., Ky. School of Med., 1897 Reidsville

Moore, E., 111. Med. Coll., 1897 Salisbury

Mast, J. R. (col.), Leonard Med. Coll., 1898 Wilmington

Moore, J. T., nongraduate Farmington

Moore, J. Edgar, nongraduate t Canton

Mock, J. H., Med. Coll. Va., 1898 Thomasville

McCain, Wm. R., Univ. of Md., 1897 McCaina

McNeill, Martin, nongraduate Red Springs

McPherson, J. W., Balto. Med. Coll., 1898 Liberty

McMillan, A. S. (col.), Leonard Med. Coll., 1898 St. Paul's

Palmer, B. H., Louisville Med. Coll., 1898 Shelby

Parker, James R., Balto. Med. Coll., 1898 Nunlola

Pendleton, A. S., Univ. of Penn., 1895 Roanoke Rapids

Pfohl, S. F., Univ. of Pa., 1894 Salem

Price, R. J., Med. Coll. of Va., 1898 Wilmington

Querry, W. L., nongraduate Querry's

Rogers, W. A., Univ. of Nashville, 1898 Franklin

Rierson, R. L., Univ. of N. Y., 1887 Elk's

Ray, John B., Balto. Med. Coll., 1898 Leaksville

Schaub, 0. P., Balto. Med. Coll., 1898 Culler

Spainhour, E. H., Balto. Med. Coll., 1898 Culler

" * Made highest grade.

920 APPENDIX.

Name and College of Graduation. Address at Time Licensed.

Stephenson, C. B., Tulane Univ. of La Charlotte

Stevens, S. A., nongraduate Monroe

Stewart, H. D., Univ. of Md., 1898 Monroe

Stringfield, Thomas, Vanderbilt Univ., 1898 Waynesville

Shaw, N. G., Louisville Med. Coll Harrell's Store

Stephens, W. F., nongraduate Ashpole

Stewart, J. T., nongraduate Red Shoals

Thomas, Herbert B., nongraduate New Bern

Thompson, J. B., Coll. P. & S., Balto., 1898 Cliffdale

Troy, Thad. S., Med. Coll. of Va., 1898 Durham

VanBergen, Chas., Univ. Paris, France Asheville

Whitley, C. C. (col.), Leonard Med. Coll., 1898 Wilmington

Woody, S. B., Vanderbilt Univ., 1892 Spring Creek

Williams, J. A., Univ. of Va Prospect Hill

Williams, J. D., Vanderbilt Univ., 1898 Lowesville

Young, J. W., Univ. of Md., 1898 Lexington

3Sth session— May, 1899, Asheville.

(Present the following members: Drs. D. T. Tayloe, T. E. Anderson,
K. P. Battle, Jr., J. Howell Way, W. H. H. Cobb, Albert Anderson, and
E. C. Register.)

Achorn, J. Warren, Med. Coll. of Maine and Bellevue Boston, Mass.

Bass, H. H., Univ. Coll. Med., Va., 1899 Rocky Mount

Brooks, T. L., Univ. Coll. Med., Va., 1899 Black Creek

Boyd, D. A., Vanderbilt Univ., 1899 Plott

Banner, C. W., Univ. of Md., 1899 Mt. Airy

Case, Calvin M., St. Louis Med. Coll Asheville

Cason, H. M. S., Univ. of Md., 1897 Edenton

Calloway, A. W., Chicago Homeop. Med. Coll., 1895 Asheville

Cardwell, G. W. (col.), Leonard Med. Coll., 1899 Reidsville

Copple, T. M., nongrad. Univ. of Md Lexington

Covington, J. M., Medico-Chir., Phila., 1899 Rockingham

Davis, T. W., Med. Coll. of S. C, 1898 Louisburg

Duson, W. W., Tulane Univ. of La., 1892 Asheville

Drewry, F. D., Med. Coll. of Va., 1898 Garysburg

Drafts, A. B., Univ. of Va., 1896 Hendersonville

Fassett, B. W., Balto. Med. Coll., 1898 Cross Roads Church

Fox, T. I., Vanderbilt Univ., 1894 Franklinsville

Fox, D. L., Vanderbilt Univ., 1894 Workville

Felts, Robert L., Univ. of Md., 1898 Charlotte

Fountain, Wm., Univ. Coll. Med., Va., 1898 Tarboro

Griffin, D. W., Univ. Coll. Med., Va., 1899 Pippetoe

Gladmon, Edwin, National Univ., D. C Southern Pines

Hall, J. C, Univ. Coll. Med., Va., 1899 Star

Hays, G. W., nongrad. Ky. School of Med Lancaster, Ky.

Heilig, H. G., Univ of Md., 1899 Salisbury

N. C. MEDICAL SOCIETY. 927

A'a»!e and College of Graduation. Address at Time Licensed.

Hunter, W. C, Medico-Chiiurg., Phila., 1899 Enfield

Heathman, J. D., nongrad. Univ. of Md Woodleaf

Hollingsworth, R. E., Univ. Coll. of Med., 1898 Mount Airy

Houston, H. C, Univ. of Nashville, 1899 Walkaps

Holt, R. D., Med. Coll. of Va., 1899 Smithfield

Isley, Wm. P., Vanderbilt Univ., 1899 Burlington

Joyner, T. 0., Univ. Coll. Med., Va., 1899 Seaboard

Joyner, C. C, Jeff. Med. Coll., 1899 Greenville

Kirby, Geo. H., Long Island Hosp. Med. Coll., 1899 Raleigh

Lamm, J. W., Univ. Coll. of Med., Va., 1899 Siler City

*Love, Lionel H, Coll. P. & S., N. Y., 1898 Wilmington

Leak, W. G., nongrad. N. C. Med. Coll Francisco

Lauderdale, W. C, Univ. of Pa., 1897 Asheville

Manning, J. H., Long Island Med. Coll., 1897 Wilmington

Maxwell, C. S., nongrad. Med. Coll of Va Mt. Olive

Meadows, W. J., Ala. Med. Coll., 1894 McAdensville

Merrimon, Louise A. (female), nongrad. Laura Memorial Med. Col.

Ohio Asheville

Miller, W. E., Coll. P. & S., Balto., 1898 Burlington

Monk, H. L., Med. Coll. of Va., 1897 Newton Grove

Moore, H. R., Atlanta Coll. P. & S., 1899 Burlington

Mewborn, J. M., Georgetown Univ., 1898 Powell's Point

McKethan, D. G., Univ. Coll. Med., Va., 1899 Fayetteville

McRae, J. D., Univ. of Nashville, 1897 Fayetteville

Nisbet, W. O., S. C. Med. Coll., 1899 Waxhaw

Noble, J. E., Jeff. Med. Coll., 1899 Greenville

Paquin, Paul, Missouri Med. Univ., 1887 Asheville

Peeler, Jno. H., Univ. Coll. Med., Va., 1899 Faith

Peavy, J. F., Med. Coll., Ala., 1888 Asheville

Ray, O. L., Univ. Med. Coll., Va., 1899 Bangor

Rakestraw, Chauncey, Ohio Med. Coll., 1894 Charlotte

Roberson, R. M., Univ. Coll. Med., Va., 1899 Pittsboro

Ross, Geo. H., Univ. of Tenn., 1899 Oakdale

Rozier, R. G., Univ. of Md., 1899 Rozier

Von Ruck, Silvio, Bellevue Med. Coll., 1899 Asheville

Smith, W. H., nongrad. Balto. Med. Coll Nashville

Smith, Jas. A., nongrad. Univ. of N. C Raleigh

Smith, J. T., N. C. Med. Coll., 1898 Westfield

Schell, S. W., Univ. Balto., 1899 Lenoir

Shore, T. W., Univ. Coll. Med., 1898 Boonville

Slate, J. S., nongrad. N. C. Med. Coll Mizpah

Smith, 0. F., Univ. Coll. Med., Va., 1899 Waycross

Steele, R. T. S., Univ. of Md., 1899 Rockingham

Slate, J. W., nongrad. N. C. Med. Coll. Quaker

Scott, Chas. L., Univ. of Md., 1898 Mebane

* Made highest grade.

928

APPENDIX.

Name and College of Graduation. Address at Time Licensed.

Tucker, H. McKee, Univ. of Md., 1899 Raleigh

Tyson, T. D., Univ. Coll. Med., Va., 1899 Covington

Van Poole, G. M., Univ. of Md Craven

White, W. M., Atlanta Coll. P. & S., 1899 Statesville

Winston, A. R., Bellevue Med. Coll., 1899 Franklinton

Wise, John S., Ky. School of Med., 1890 Chester, S. C.

Whitehead, J. P., Univ. of Md., 1899 Rocky Mount

Wilson, Ida M. (female), Ohio Med. Coll., 1896 Charlotte

Wimberly, J. P., Jeff. Med. Coll., 1899 Rocky Mount

' Wright, J. B., Univ. Coll. of Med., Va., 1899 Chassie

Widby, E. J., Balto Univ., 1897 Lenoir

Walker, L. A., Univ. Coll. of Med., 1898 Stony Creek

Ward, F. A., Med. Coll. of Va., 1898 ■ Gliden

Yarborough, R. F., Columbian Univ., D. C, 1898 Louisburg

Thomson, J. R., Univ. Coll. Med., Va., 1899 Cally

39th session— May, 1900, Tarboro.

(Members of the board present: Drs. D. T. Tayloe, Thos. Eli Ander-
son, J. Howell Way, K. P. Battle, Jr., E. C. Register, Albert Anderson
and W. H. H. Cobb.)

Brown, Geo. W., Ky. School Med., 1898 Covington

Bi-own, Edward, Balto. Med. Coll Greensboro

*Borden, Sallie (female), Woman's Med. Coll., N. Y., 1899. . .Goldsboro

Bell, Gaston Graham, Univ. Coll. Med., Va., 1900 Elizabeth City

Ballard, S. E., Balto. Med. Coll., 1897 Saginaw

Buffaloe, J. S., Balto. Med. Coll., 1900 Garner's

Bynum, Wade H., Univ. Coll. Med., Va., 1900 Germanton

Bryson, Dan'l R., Univ. of Md., 1900 Bryson City

Cloninger, L. V., N. C. Med. Coll., 1900 Stanley

Cromartie, R. S., N. C. Med. Coll., 1900 Garland

*Dixon, E. D. (female). Woman's Med. Coll., N. Y., 1895 Raleigh

Dunn, Wm. L., Univ. of Mich., 1900 Asheville

Earl, Edgar H., Coll. P. & S., Ontario, 1886 Rochester, N. Y.

Edwards, Sam'l, Univ. of Md., 1897 Goldsboro

Evans, L. B., Univ. Med. Coll., Va., 1900 Idaho

Fauntleroy, J. W., Coll. P. & S., N. Y., 1896 Saluda

Fortune, A. F., Univ. Med. Coll., Va., 1900 Greensboro

Glenn, H. F., Coll. P. & S., Atlanta, 1900 Gastonia

Greene, J. C, Med. Coll., Va., 1900 Greenville

Hauser, Wm. H., N. C. Med. Coll., 1900 Shelby

Hines, C. H. (col.), Leonard Med. Coll., 1900 Smithfield

Henderson, B. H. (col.), Howard Univ., 1897 Fayetteville

Hunt, J. F., Univ. of Tenn., 1900 Fallston

Hoyt, A. C, Univ. of Md., 1900 Winston

Harrison, Edmund, Univ. Coll. Med., 1896 Greensboro

* Made highest grade.

N. C. MEDICAL SOCIETY. 929

Name and College of Graduation. Address at Time Licensed.

Jones, Lucy C. (female), Syra. Med. Coll., N. Y., 1898. .New York, N. Y.

Kluttz, W. C, Univ. of Penn., 1899 Salisbury

Moss, W. H., Univ. of Ga., 1892 Charlotte

Mills, Chas. H. C, Univ. of Md., 1897 Charlotte

Miller, Robt. B., Med. Coll., Va., 1898 Richmond

Mitchell, W. F., Univ. of Md., 1899 Shelby

Melvin, W. C, Univ. Coll. Med., Va., 1900 Winnie

McPhail, L. D., Univ. of Md., 1900 Clinton

McRae, Neill, Univ. Med. Coll., Va., 1900 Fayetteville

Nixon, E. J., Univ. of Md., 1900 Wilmington

Newman, W. A., Med. Coll., Va., 187G Salisbury

Powell, H. G., Coll. P. & S., Atlanta, 1900 Fair Bluff

Pollock, Raymond, Jeff. Med. Coll., 1897 Winston

Patrick, J. E., Univ. Med. Coll., Va., 1900 Institute

Price, Geo. E., Univ. of Penn., 1898 Sapphire

Pate, Geo. M., S. C. Med. Coll., 1900 Gibson

Reid, W. E. (col.), Leonard Med. Coll., 1900 Gatesville

Sikes, Geo. L., Univ. Med. Coll., 1900 Clinton

Stokes, J. Ernest, Univ. of Md., 1892 Salisbury

Shaffner, F. J., Jr., Univ. of Pa., 1899 Winston

Stratford, Wm. Henry, Univ. Med. Coll., Va., 1900 Greensboro

Thigpen, W. J., Jeff. Med. Coll., 1900 Conetoe

Wessell, J. C, Univ. of Md., 1900 Wilmington

Watkins, G. S., Univ. Med. Coll., 1900 Cornwall

West, R. M., Med. Coll. of Va., 1900 Salisbury

Worstell, Gaylord, Columbian Univ., D. C, 1899 Cherokee

Witherspoon, B. J., Med. Coll. of S. C, 1894 Charlotte

Watson, Leon, N. C. Med. Coll., 1900 Broadway

40th SESSION— May, 1901, Durham.

(Members of board present: Drs. E. C. Register, J. Howell Way, D. T.
Tayloe, Thomas E. Anderson, Albert Anderson, T. S. McMullan, and
Jno. C. Walton.)

Abernethy, Eric A., Univ. Med. Coll., Va., 1901 Chapel Hill

Allen, Joseph A., Univ. Med. Coll., Va., 1901 Poindexter

Ballenger, Edgar G., Univ. of Md., 1901 Tryon City

Briggs, Henry H., Yale University, 1897 Asheville

Benton, Geo. Ruffin, Med. Coll. of Va., 1901 Wilson

Brawley, R. Vance, Univ. Med. Coll., Va., 1901 Mooresville

Candler, Chas. Z., Coll. P. & S., Atlanta, 1901 Dillsboro

Cotton, Clyde E., Univ. of Wooster, O., 1889 Black Mountain

Davis, Hoagland C, N. C. Med. Coll., 1901 Fayetteville

Drake, John H., Med. Coll. of Ala., 1891 Asheville

Dixon, Wm. Henry, Med. Coll. of Va., 1901 Edwards,

Dicks, James F., Univ. Med. Coll., Va., 1901 Walkerton

930 APPENDIX.

Name and College of Graduation. Address at Time Licensed.

Edwards, Arthur J., Univ. of N. Y., 1901 Winston

Early, Wm. Wallace, Univ. of Pa., 1893 Aulander

Foscue, Jno. E., Univ. of Md., 1901 Pollocksville

Fearing, Zeno, Univ. Med. Coll., Va., 1901 Elizabeth City

Green, Thos. M., Univ. of Md., 1901 Wilmington

Ginn, Theo. L., Med. Coll. of Va., 1901 Goldsboro

Goley, Wm. R., Univ. Med. Coll., Va., 1901 East Durham

Garner, Eobt. H., Univ. of Nashville, 1900 Lineolnton

Garland, David L., Univ. of Nashville, 1901 Rabun Gap, Ga.

*Graham, Wm. Alexander, Univ. of Pa., 1899 Durham

Hart, E. Roland. Univ. of Md., 1901 Tarboro

Holmes, Lawrence E., Univ. of Pa., 1897 Billmore

Herring, Benj. S., Univ. of Mich., 1900 Wilson

Hargrave, Wm. F., Univ. of Md., 1901 Baltimore, Md.

Hollowdy, Oscar W., Med. Coll. of Va., 1901 Gorman

Honnett, J. H., Coll. P. & S., N. Y., 1900 Wilmington

Hargrove, Frank S. (col.), Leonard Med. Coll Lexington

Hiatt, John T., Coll. P. & S., Atlanta, 1901 Ellerlie

Highsmith, Seavy, Univ. Coll. Med., Va., 1901 Parkersburg

Hooks, Ethelred, Med. Coll., Va., 1901 Fremont

Hunter, Henry Holmes, Med. of Coll. Va., 1900 Somerton

Hocutt, John Irving, Univ. Med. Coll., Va., 1900 Emmit

Hughes, Claude M., Atlanta Med. Coll., 1897 Cedar Grove

Jurney, Peter C, Med. Coll. of Va., 1901 Olin

Johnson, Robert W., Univ. of Tenn., 1900 Oakdale

Jones, Arthur L., Univ. Coll. Med., 1901 Silas Creek

Kapp, Henry H., Jeff. Med. Coll., 1901 Bethania

Kirk, Wm. Reddin, Central Univ. of Ky., 1890 Hendersonville

Kornegay, W. Emmett, Univ. of Md Baltimore, Md.

Maxwell, Geo. M., N. C. Med. Coll., 1901 Davidson

Morse, Lucius B., Chicago Homeop. Med. Coll., 1895 Asheville

Moore, Tilon V., Balto. Med. Coll., 1901 Phoenix

Monroe, John P., Coll. P. & S., Balto., 1901 Sanford

Meadows, Elijah B., Univ. Med. Coll., Va., 1901 Oxford

MeFayden, Paul R., Univ. Coll. Med., 1901 Clarkton

McBryde, M. Hugh, Univ. Med. Coll., Va., 1901 L. R. Academy

McKeethan, John A., N. C. Med. Coll., 1901 Fayetteville

McEachern, Ed. C, Univ. of Md., 1901 Wilmington

McGregor, Geo. W., Darmouth Med. Coll., 1878 Littleton, N. H.

Newby, Geo. E., Jeff. Med. Coll., 1900 Reading, Pa.

Orr, Peter B., Jeff. Med. Coll., 1901 Asheville

Peacock, Walter J., Tulane Univ. of La., 1901 Salisbury

Prioleau, W. H., Jr., Med. Coll. of S. C, 1893 Asheville

Pridgeon, Leonard C, Jeff. Med. Coll., 1901 Kinston

Parker, John E., Univ. Coll. of Med., 1901 Laws

* Made highest grade.

N. C. MEDICAL SOCIETY. 931

'Name and College of Graduation. Address at Time Licensed.

Rogers, Francis 0., Univ. of Md., 1901 Concord

Eankin, Watson S., Univ. of Md., 1901 Erskine

Rose, Augustus S., Univ. Med. Coll., Va., 1901 Fayetteville

Staley, S. Walter, Med. Coll. of S. C, 1901 Liberty

Shepherd, C. H. (col.) , Leonard Med. Coll., 1901 Raleigh

Speight, E. H. Jr., Univ. of Md., 1901 Wrendale

Self, L. Lester, Univ. Med. Coll., Va., 1901 Lincolnton

Skinner, L. C, Univ. of Md., 1901 Greenville

Sherrill, Albert, Univ. Med. Coll., Va., 1901 Lenoir

Tucker, John Hill, Jr., Univ. of Va., 1899 Henderson

Taylor, W. L., Univ. of Va., 1900 Stovall

Thompson, C. D., Univ. of Tenn., 1901 Harden

Tuttle, Andrew F., N. C. Med College, 1901 Germanton

Thomas, Ed. A., Univ. of Pa., 1891 Ashland, Ky.

Thompson, Dunlap, Univ. of Md., 1901 Morven

Underbill, Henry P., Univ. Med. Coll., Va., 1901 Selma

Woodruff, A. C, N. C. Med. Coll., 1901 Enterprise

Watson, Sam'l P., Univ. of Md., 1901 Rock Hill, S. C.

Williams, Albert F., Univ. of Md., 1901 Kenansville

Zimmerman, Robt. N., N. C. Med. Coll., 1901 Enterprise

41ST SESSION— June, 1902, Wilmington.

(Members present: Drs. E. C. Register, J. Howell Way, D. T. Tayloe,
T. E. Anderson, Albert Anderson, Jno. C. Walton and Thos. S. McMul-
lan. )

Anders, McTyeire G., Md. Med. Coll., 1901 Connelly's Springs

Bailey, Joseph W., Coll. P. & S., St. Louis, 1901 Mineral Springs

Ballou, James L., Univ. of Nashville, 1901 Crumplers

Barnes, Benj. F., Univ. of Md., 1902 Elm City

Brown, Clarence S. (col.), Leonard Med. Coll., 1901 Winton

Boone, Wm. H., N. C. Med. Coll., 1902 Morrisville

Blackwell, Edith B. (fem.). Woman's Med. Coll., N. Y., 1891 .Greensboro

Bellamy, R. H., Jeff. Med. Coll., 1902 Wilmington

Cathell, J. Edwin, Univ. of Md., 1899 Tyro Shops

Collier, Geo. Kirby, Coll. P. & S., Balto., 1900 Wilmington

Cooke, Fred. K., Tulane Univ. of La., 1901 Louisburg

Costner, Geo. H., Univ. of Md., 1901 Lincolnton

Covington, Lewis C, Univ. Coll. of Med., Va., 1901 Vanceboro

Duncan, Cnas. L., Univ. of Md., 1902 Beaufort

English, Edwin S., Univ. of South, Tenn., 1901 Brevard

Edwards, Geo. P., Univ. of Ga., 1902 Hildebran

Exum, Wyatt, Jr., Med. Coll. of Va., 1901 Saulston

Frampton, James, S. C. Med. Coll., 1894 Hendersonville

Gayle, Ed. M., Univ. of Va., 1902 Warrenton

Grant, W. H., Dartmouth Med. Coll., 1859 Pine Bluff

932 APPENDIX.

Name and College of Graduation. Address at Time Licensed.

*Guerrard, Arthur R., Bellevue Med. Coll., 1899 Flat Rock

Graham, Joseph, Univ. of Pa., 1901 Hillsboro

Hayden, Catherine Phoebe (female), Univ. of Col., 1894 Raleigh

Hennessee, E. Augustus, U. S. Grant Univ., 1897 Glen Alpine

Hicks, Isham F., N. C. Med. Coll., 1902 Faison

Hardy, Ira May, Med. Coll. of Va., 1901 Washington

Hauser, Emanuel Olin, Balto. Univ., 1902 Fallston

Harrill, Lawson B., U. S. Grant Univ., 1897 Caroleen

Harris, John L., Univ. of Md., 1902 Winston

Huntington, Geo., Coll. P. & S., N. Y., 1871

Hunter, Joseph McK., Louisv'l Med. Coll., 1896 Cherryville

Johnson, Richard H., Univ. of Md., 1894 Baltimore, Md.

Jones, John Walter, U. S. Grant Univ., 1900 Boone

King, Parks M., Bellevue Med. Coll., 1902 Charlotte

Kirkpatriek, L. R., K C. Med. Coll., 1902 Blackstock

Keerans, L. C, Univ. of Md., 1902 Charlotte

Lane, Wm. K., Jeff. Med. Coll., 1902 Goldsboro

Munroe, Henry S., N. C. Med. Coll., 1902 Lenoir

Maxwell, Henry B., Univ. of Md., 1902 Whiteville

Morton, Geo. E., Univ. of Ga., 1902 Vance County

Matheson, J. P., N. C. Med. Coll., 1902 • Taylorsville

McCraeken, J. Rufus, N. C. Med. College, 1902 Clyde

Mclver, Lynn, Univ. of Ky., 1901 Sanford

McLean, John W., N. C. Med. Coll., 1902 Cameron

McQueen, A. B., N. C. Med. Coll., 1902 Fayetteville

Gates, George, Univ. of Louisv'l, 1894 Grover

Paddison, John Robert Jr., Univ. of Md., 1902 Mt. Airy

Phifer, Fred W., Univ. of Md., 1902 Statesville

Phifer, Ed. Wm., N. C. Med. Coll., 1902 Morganton

Reid, Chas. E., Jeff. Med. Coll., 1895 Hot Springs

Reitzel, Claude E., Coll. P. & S., Atlanta, 1902 Liberty

Russell, Lloyd P., Univ. of Nashville, 1901 Fletcher

Rogers, McLain, Coll. P. & S., Atlanta, 1902 Clyde

Rogers, Carey P., Johns Hopkins Univ., 1902 Raleigh

Skinner, Lewis C, N. C. Med. Coll., 1902 Davidson

Sharp, Wm. B. (col.), Leonard Med. Coll., 1901 Harrellsville

Shuford, Jacob H., Univ. of Mich., 1901 Hickory

Taylor, James Nath., Med. Coll. of Va., 1901 Pittsboro

Thomas, Pride Jones, Univ, of Md., 1902 Wilmington

Walker, Herbert D., Univ. of Md., 1902 Creswell

Wilson, Hugh, Univ. of Ga., 1891 William's Mills

Wiseman, C. Baxter, Coll. P. & S., Balto., 1902 Henrietta

Williams, James M., Univ. of Md., 1902 Warren

Watkins, Jas. W. (col.), Leonard Med. Coll., 1901 Reidsville

Woltz, John L., Southern Med. Coll., 1877 London

* Made highest grade.

N^. C. MEDICAL SOCIETY. 93i>

Name aiid College of Graduation. Address at Time Licensed.

Williams, Peter H. (col.), Leonard Med. Coll., 1901 Raleigh

Walker, John W. (col.), Leonard Med. Coll., 1902 Asheville

Washam, Wm. Worth, N. C. Med. Coll., 1902 Conover's Ford

Waite, Herbert H., Univ. of Mich., 1901 Asheville

Withers, Samuel, N. C. Med. Coll., 1902 Davidson

Yount, Eugene McD., N. C. Med Coll., 1902 Conover

Sisk, James A., N. C. Med. Coll., 1902 Harmony

42d session— June, 1903, Hot Springs.

(Members Board present: Drs. M. H. Fletcher, Geo. W. Pressl}-, A. A.
Kent, Chas. O'H. Laughinghouse, J. T. J. Battle, Jas. M. Parrott and
F. H. Russell.)

Adams, Lyttle C, N. C-. Med. Coll., 1903 Jonesville

Alston, Willis Jr., Univ. of Md., 1903 Littleton

Aydlette, Joseph P., Univ. of Ky., 1901 Earl

Brown, Thomas E. W., Coll. P. & S., N. Y., 1900 Asheville

Boyles, Joseph H., Coll. P. & S., Balto., 1903 Greensboro

Cowles, Henry C, Jr., Coll. P. & S., N. Y., 1903 Statesville

Coppedge, Neilson P., N. C. Med. College, 1903 Rockingham

Coppedge, Lewellyn J., N. C. Med. Coll., 1903 Rockingham

Clemenger, Francis J., Univ. of Denver, 1902 Asheville

Chestnut, Dallas W. (col.), Leonard Med. Coll Wilmington

Carroll, John W., Univ. of Md., 1903 Raleigh

Caveness, Alfred H., Balto. Univ., 1901 Coleridge

Caveness, Zebulon M., Univ. of N. C, 1903 Greensboro

Childs, Julius A., S. C. Med. Coll., 1888 Hickory

Campbell, R. A., St. Louis Med. Coll., 1875 Pine Bluff

Davis Job W., Med. Coll. of Va., 1903 Veruna

Dosher, Julius A., Balto. Med. Coll., 1903 Southport

Dixon, Guy E., Coll. P. & S., St. Louis, 1903 Belwood

Daniels, Oscar C, Med. Coll. of Va., 1903 Oriental

Decs, Daniel A., Balto. Med. Coll., 1903 Grantsboro

DeCorniss, Jos. L., Univ. of Md., 1903 Shawsboro

Edwards, Charles P., Tenn. Med. Coll Bald Creek

Flow, James W., N. C. Med. Coll., 1898 Glass

Fowlkes, John I., Coll. P. & S., Atlanta, 1903 ' Rockingham

Greenwood, Solomon E., Tenn. Med. Coll., 1902 Mascot

George, David S., N. C. Med. Coll., 1903 Buck Slioals

Gilmore, Willis D., Univ. of N. C, 1903 Raleigh

Hawkins, Pompey L. (col.), Leonard Med. Coll., 1903 Kittrell

Hall, Price B., N. C. Med. Coll., 1903 Belmont

Hoover, Chas. H., Balto. Med. Coll., 1903 Crimsie

Hammond, Alfred T., Univ. Coll. of Med., 1903 Trenton

Johnson, Thos. C, Med. Coll. of Va., 1903 Tomahawk

Johnson, Floyd, IMemphis Hosp. Coll. of Med., 1903 Benson

Jones, Frank, Balto. Med. Coll., 1903 Thermal City

934 APPENDIX.

Name and College of Graduation. Address at Time Licensed.

Jones, Wm. M. Jr., Univ. of Md., 1903 Asheville

King, Richard M., Jeff. Med. Coll., 1903 Philadelphia, Pa.

Linville, W. Clinton, Univ. of Md., 1903 Kernersville

Lilly, James L., Univ. Coll. of Med., Va., 1903 Mt. Gilead

*Little, Thos. R., Univ. of Pa., 1900 Greensboro

Long, Chas. L., Coll. P. & S., 1884 Pine Bluff

Mann, Thos. A., Univ. of Md., 1903 Baltimore, Md.

Mariner, Napoleon B., Univ. Coll. of Med., Va., 1903 Jamesville

Murphy, Wm. B. Jr., Univ. Coll. of Med., Va., 1903 Tomahawk

Mason, Robert E., Univ. of Ga., 1900 Charlotte

Matthews, Martin L., Univ. of N. C, 1903 East Bend

Montgomery, H. M., N. C. Med. Coll., 1903 Burlington

Murphy, J. Gerald, Univ. of Louisv'l, 1903 Atkinson

McFayden, Archibald A., N. C. Med. Coll., 1903 Raeford

McNider, Wm. deB., Univ. of N. C, 1903 Raleigh

McPherson, S. D., Univ. of Md., 1903 Liberty

Norton, Chas. F., Univ. of Texas, 1899 Asheville

Nichols, James T., Denver & Gross Med. Coll., 1903 Barnard

Outlaw, James B., Memphis Hosp. Coll. of Med., 1902 Goldsboro

Petrie, Robert W., Univ. of Md., 1903 Reepsville

Pethel, James W, (col.), Howard Univ., 1900 Charlotte

Proffit Thos. J., Univ. of Louisv'll, 1903 Sugar Grove

Patterson, Ector G., Univ. of Md., 1903 Liberty

Pollard, Walter B., Univ. of Pa., 1899 Hamilton

Reynolds, John, Louisville Med. Coll., 1903 Asheville

Reynolds, James Herbert, Louisville Med. Coll., 1903 Asheville

Robinson, Willard F., Vanderbilt Univ., 1896 Mars Hill

Robinson, Wm. A., Univ. Coll., of Med., Va., 1900 Brink, Va.

Strohecker, Thomas A., N. C. Med. Coll., 1902 Davidson

Sraoot, Morris L., Univ. Coll. Med., 1903 Salisbury

Sawyer, Walter W., Univ. of Md., 1903 Elizabeth City

Slate, Wesley C, Univ. of Tenn., 1903 Quaker

Sayers, SamT R., Univ. of Va., 1900 Hamlet

Thigpen, Guy F., Univ. of Md., 1903 Mildred

Walker, Walter E., Med. Coll. of Va., 1903 Richmond

Williams, Claude B., Univ. Coll. Med., Va., 1903 Elizabeth City

Wilkins, Sam'l A., Ky. Univ. 1902 Dallas

Wilson, Clarence L., N. C. Med. Coll., 1903 Newton

Whittaker, Asa C, Univ. of Tenn., 1903 Devon

Was, John W., Univ. of Mich., 1878 Asheville

Wood, Edward Jenner, Univ. of Pa., 1902 Wilmington

Valentine, Thos. H., Univ. Coll. of Med., Va., 1901 Voltare

Zimmerman, Chas. St. V., Nat. Univ., D. C, 1895 Asheville

* Made highest grade.

X. C. MEDICAL SOCIETY. 935

43d session— May, 1904, Raleigh.

(Members of board present: Drs. il. H. Fletcher, J. M. Parrott,
J. T. J. Battle, F. H. Eussell, A. A. Kent, Chas. O'H. Laughinghouse
and Geo. W. Pressly. )

Name and College of Graduation. Address at Time Licensed.

Abbott, Eulalie M. (female), Boston Univ., 1879 High Point

Anderson, Paul V., Univ. of Va., 1904 Wilson

Anderson, Wade H., University of Va., 1902 Wilson

AUen, Benj. G., Columbia University, 1904 Henderson

Andrews, Robert M., Memphis Hosp. Coll. of Med., 1901 Cliffdale

Baird, Campbell A., N. C. Med. Coll., 1904 Bethel Hill

Beam, Jasper L., Coll. P. & S., Atlanta, 1899 Grouse

Bowman, Hugh E., N. C. Med. Coll., 1904 Davidson

Blair, A. McNeil, Niagara Univ., 1897 Southern Pines

Bradsher, Wm. A., Univ. of Md., 1904 Roxboro

Billings, Arthur E., N. C. Med. Coll., 1904 Charlotte

Bourneman, John H., Jeflf. Med. Coll., 1903 Wilmington

Bradford, Robert H., N. C. Med. Coll., 1904 Charlotte

BusbJ^ Julian G., Univ. of Md., 1904 Salisbury

Bradshaw, James I., Tenn. Med. Coll., 1901 Relief

Chapman, Geo. M., U. S. Grant Univ., 1897 Logan's Store

Craven, W. W., Univ. of Md., 1903 McKeesport, Pa.

Coffman, Wm. H., P. & S., Balto., 18^4 Asheville

Dalton, W. N., N. C. Med. Coll., 1904 Danbury

Davis, Joe T., Univ. Coll. Med., 1903 Gumberry

Edwards, Arthur D., Univ. of Md., 1903 N. Wilkesboro

Everhart, W. H., Univ. of Md., 1903 Newton

Ferrebee, Celius G., Med. Coll. of Va., 1902 Shiloh

Garner, H. A., Univ. of Md., 1902 Asheville

Gibbs, John B., N. C. Med. Coll., 1904 Burnsville

Green, Arthur W., Univ. Coll. Med., Va., 1904 Powellsville

*Guthrie, Marshall C, Univ. of N. C, 1904 Raleigh

Hicks, Calvin S., Univ. of Md., 1904 Durham

Hovis, L. W., N. C. Med. Coll., 1904 Charlotte

Highway, S. C, Med. Coll., Ohio, 1885 Murphy

Hoffler, E. D. (col.), Leonard Med. Coll., 1904 Greenville

Holt, Thos. J., Med. Coll. of Va., 1904 Smithfield

Justice, James T., N. C. Med. Coll., 1904 Jacksonville

Laton, J. F., N. C. Med. Coll., 1904 Albemarle

Lee, S. P. J., Md. Med. Coll., 1904 Dunn

Lockett, E. A., Univ. of Pa., 1902 Winston

Lamb, B. C, Univ. of Md., 1903 Elizabeth City

Littlejohn, R. N. Jr., Univ. of Md., 1903 Charlotte

Lyon, E. H., Univ. of Md., 1903 Stem

Love, B. E., Univ. of Md., 1904 Leesburg

* Made highest grade.

936 APPEiSTDIX.

Name and College of Graduation. Address at Time Licensed.

Lowry, J. Robert, Univ. of Md., 1904 County Line

Martin, John H., Univ. Nashville, 1903 Poindexter

Moore, W. T., Univ. of South, 1904 Voltaire

Miles, May S. (female), Laura Mem. Coll., Ohio, 1898 Greensboro

Myers, John Q., N. C. Med. Coll., 1904 Wilkesboro

McGehee, John W., Univ. of Md., 1904 Madison

Mclntyre, Dugald G., N. C. Med. Coll., 1904 Lumborton

McLean, Chas. E., N. C. Med. Coll., 1903 Gastonia

Nichols, A. A., Univ. of Nashville, 1898 Painter

Nicholson, John L., Univ. of Md., 1904 Washington

Orr, Chas. C, Univ. of Md., 1904 Charlotte

Orr, Robert J., Louisville Med. Coll., 1893 Brevard

Orr, Nathan A., Univ. Coll. of Med., Va., 1899 Charlotte

Plummer, John O. (col.), Leonard Med. Coll., 1904 Warrenton

Phillips, J. B., Jr., Univ. of Md., 1903 Spring Ho^je

Reynolds, Thos. F., N. C. Med. Coll., 1904 Leicester

Riddle, Jos. B., Vanderbilt University, 1898 Bridgewater

Reed, D. H., Columbian Univ. D. C, 1901 Washington, D. C.

Salmons, H. C, N. C. Med. Coll., 1904 Buck Shoals

Sharpe, Frank L., Univ. of N. C, 1904 Statesville

Strong, Wm. M., N. C. Med. Coll., 1904 Charlotte

Simpson, W. P., Univ. of Va., 1903 Wilson

Stanley, John H., Univ. of N. C, 1904 Raleigh

Smith, W. F., N. C. Med. Coll., 1904 Salisbury

Stewart, James J., N. C. Med. Coll., 1904 Newton

Thompson, Hugh R., Univ. Coll. of Med., Va., 1902 Reidsville

Ward, Jesse E., Univ. of Md., 1904 Wilson

Williams, John R., Univ. of Mich., 1903 Asheville

Willis, Arthur P., Univ. of N. C, 1905 Cana

Windley, R. P., Univ. of Md., 1903 Lake Landing

Wright, Thos. H., Univ. of Va., 1902

Wright, Otho C, Coll. P. & S., Balto., 1893

Woodard, Chas. A., Univ. of Va., 1904 Wilson

Young-High, Carolina J., Univ. of Mich., 1897

Taylor, W. L, N. C. Med. Coll., 1902 Harrellsville

44th session— May, 1905, Greensboro.

(Members of Board present: Drs. Chas. O'H. Laughinghouse, Geo.
W. Pressly, A. A. Kent, James M. Parrott, J. T. J. Battle, M. H. Fletcher,
and F. H. Russell.)

Ashton, Fielding L., Univ. Coll. of Med., 1905 Richmond, Va.

Archer, Isaac J., Northwestern Univ., 111., 189G Black Mountain

Arnold, Lourie J., N. C. Med. Coll., 1905 Sanford

Akerman, Joseph, Johns Hopkins Med. Coll., 1900 Wilmington

Battle, Ivan P., Jeff. Med. Coll., 1904 Rocky Mount

Baxter, John N. (col.), Leonard Med. Coll., 1905 Rocky Mount

N. C. MEDICAL, SOCIETY. 937

Name mid College of Graduation. Address at Time Licensed.

Blake, Joseph F., N. C. Med. Coll., 1905 Chadbourn

Brooks, Baird N., Univ. of Md., 1905 Nashville

Barnett, Isaac E., Tenn. Med. Coll., 1901 White Rock

Brunfield, Wm. A., Univ. of Va., 1897 Eenan, Va.

Bostic, Wm. C, N. C. Med. Coll., 1905 Forest City

Basnight, Tlios. G., Univ. of Md., 1904 Stokea

Benton, Ashley M., N. C. Med. Coll., 1905 Evergreen

Bonner, Kemp P. B., Med. Coll. of Va., 1905 Aurora

Brookshire, Harley G., N. C. Med. Coll., 1905 Emma

Cooper, Geo. M., Univ. Med. Coll., Va., 1905 Clinton

Christian, Andrew J. (col.), Leonard Med. Coll., 1905 Winston

Carroll, Robert S., Rush Med. Coll., 1897 Asheville

Carroll, John L., Louisville Med. Coll., 1905 Asheville

Cocke, Jere L., Louisville Med. Coll., 1905 Asheville

Caldwell, Julius A., Jr., Johns Hopkins, 1904 Salisbury

Cramer, John B., Univ. of N. C, 1905 Chapel Hill

Carroway, James F., Med. Coll. of S. C. 1900 Asheville

Clodfelter, Chas. M., P. & S., Balto., 1905 Lexington

Cooke, Linton H., Univ. of N. C Aulander

Croom, Arthur B., Univ. of Ma., 1905 Maxton

Donnelly, John, Univ. of N. C, 1905 Charlotte

Duguid, James A., N. C. Med. Coll., 1905 New Bern

Dye, John C, N. C. Med. Coll., 1905 Fayetteville

Disosway, Alpheus W., Univ. of Md., 1905 New Bern

Deshazo, Wm. D., Univ. of Md., 1905 Spencer, Va.

Eberle, Harry A., McGill Univ., 1876 Greensboro

Farrar, Mont. R., Univ. of N. C, 1905 Greensboro

Flagge, Phillip W., Washington Univ., 1902 Greensboro

Garrigues, Henry J., Univ. Copenhagen, 1869 Tryon

Edwards Bertie O., N. C. Med. Coll., 1905 Lamel Springs

Faust, De Lacy, N. C. Med. Coll., 1905 Liberty

Gibson, Milton R., Univ. of Md., 1905 Gibson

Gibson, John S., Univ. of Md., 1905 Gibson

Graham, Archibald W., Univ. of Md., 1905 Charlotte

Harrison, Henry H., Jeff. Med. Coll., 1905 Enfield

Harrison, John S. Med. Coll. of Va., 1903 Elm City

Halford, Joseph W., N. C. Med. Coll., 1905 Chalybeate Springs

Haynes, Baxter M., N. C. Med. Coll., 1905 Cliffside

Harbeck, Edward V., N. C. Med. Coll., 1905 Gem

Hill, Geo. S., Harvard Univ., 1899 Marblehead, Mass.

Hooper, Delos D., Univ. Med. Coll., Va., 1905 Tuckaseigee

Jacox, Richard C. (col.), Leonard Med. Coll., 1902 Franklin, Va.

Johnston, Livingston F., Jeff. Med. Coll., 1905 Wallace

Johnson, Alice E. (female), Wom. Med. Coll., Phila., 1905. .South. Pines
l^ander, J. 'i., Univ. Coll. Med., Va., 1905 Chinquepin

938 APPENDIX.

Tslame and College of Graduation. Address at Time Licensed.

Long, W. Talmage, Balto. Med. Coll., 1905 Roxboio

Kafer, Oswald O., Univ. of Md., 1905 New Bern

Mebane, VVni. C, N. C. Med. Coll., 1905 Mt. Airy

Martm, J. Floyd, N. C. Med. Coll., 1905 Yadkinville

Moore, Joseph N., Tulane Univ. of La., 1905 Wilson

Moore, Baxter S., Univ. of Va., 1902 Charlotte

Moncure, Wni., Univ. of Penn., 1902 Raleigh

Morgan, Cassius H., Tenn. Med. Coll., 1901 Higgins

McKaig, Frisby T., Univ. of Ala., 1890 Robbinsville

MePhail, Wilbur A., Univ. of Nashville, 1904 Ashpole

McCombs, Cyrus J., N. C. Med. Coll., 1905 Mint Hill

McCauley, L. E. (col.), Leonard Med. Coll., 1905 Raleigh

*Newell, Leon B., Univ. of N. C, 1905 Ne wells

Nalle, Brodie C, Univ. of Va., 1903 Charlotte

Norman, Joseph H., Tulane Univ. of La., 1905 Brinkleyville

Person, Edgar C, Med. Coll. of Va., 1905 Pikeville

Proctor, J. Peebles, Univ. Coll. of Med., Va., 1903 Williamston

Perry, Henry B., N. C. Med. Coll., 1905 Sweet Water

Phillips, James J., Coll. P. & S., N. Y., 1904 Tarboro

Pritchard, Arthur T., Jeff. Med. Coll., 1905 Asheville

Rows, Herbert E., N. C. Med. Coll., 1905 '. Newton

Reeves, Wm. P., Univ. of South, 1903 Greensboro

Sloop, Eustace H., N. C. Med. Coll., 1905 Mooresville

Sutton, Carl W., Tulane Univ. of La., 1905 La Grange

Stevens, R. S., Univ. of N. C, 1905 Smithfield

Sally, Edward McQ., Univ. of Md., 1905 Try on

Smith, Owen, Jeff. Med. Coll., 1904 Asheville

Summers, Joseph W., N. C. Med. Coll., 1905 ' Davidson

Saunders, Joseph H., Univ. Coll. of Med., Va., 1905 Washington

Stringfield, Samuel, Jeff. Med. Coll., 1905 Waynesville

Stone, James A., Univ. of Md., 1905 Shallotte

Thomas, Edmund L. (col.), Leonard Med. Coll., 1905 Charlotte

Tillotson, Squire F., N. C. Med. Coll., 1905 King

Webb, Lorenzo S., Univ. of N. C, 1905 Windsor

Wells, James M., N. C. Med. Coll., 1905 Shelby

Walker, Emmett E., Univ. Coll. Med., Va., 1900 Snow Hill

Witherbee, Wm. D., McGill Univ., 1899 Charlotte

Woodson, Chas W., Coll. P. & S., N. Y., 1904 Salisbury

Wyatt, James L., Medico-Chi. Phila., 1905 Wadesboro

Whitaker, Joel, Univ. of Md., 1905 Raleigh

Williams, J. B. Jr., Balto. Med. Coll., 1896 Oxford

* Made highest grade.

N. C. MEDICAL SOCIETY. 939

4eth SESSION— May, 1906, Charlotte.

(Board present: Drs. A. A. Kent, Chas. O'H. Laughinghouse, M. H.
Fletcher, James M. Parrott, J. T. J. Battle, Frank H. Russell and Geo. W.
Pressly. )

iYa/«e and College of Graduation. Address at Time Licensed.

Allen, Wm., P. & S., Balto., 1906 Lexington, Va.

Abernathy, Miles B., N. C. Med. Coll., 1906 Charlotte

Abernathy, Claude 0., University of N. C Chapel Hill

Berkley, Greenville R., Jeff. Med. Coll., 1906 Atlanta

Byers, James A. (col.) , Leonard Med. Coll., 1906 Greensboro

Burnett, Peter VV. (col.) Leonard Med. Coll., 1906 Oak City

Boyee, John M., N. C. Med. Coll., 1903 Whitevifle

Boger, ban'l T., N. C. Med. Coll., 1906 Unionville

Bowers, Albert H., Univ. Coll. of Med., 1906 Thomasville

Beall, Louio G., N. C. Med. Coll., 1906 Greensboro

Carr, John R., Johns Hopkins, 1904 Durham

Carlton, R. L., Univ. of Md., 1906 N. Wilkesboro

Casteel, Lewis R., Vanderbilt Univ., 1893 Culberson

Currie, Dan'l S., N. C. Med. Coll., 1906 Maxton

Carstarphen, Wm. T., Jeff. Med. Coll., 1906 Garysburg

Carpenter, Forest A., N. C. Med. Coll., 1906 Henrietta

Clark, Geo. T., N. C. Med. Coll., 1906 Sandifer

Caldwell, Milton M., Jeff. Med. Coll., 1901 Concord

Coffey, Lawrence H., Med. Coll. of Va., 1906 Colfeys

Corpening, Oscar J., Univ. Coll. of Med., 1906 Lenoir

Chalmers, Henry C, Univ. of Va., 1905 Woodsdale

Clement, Edward B., Jeff. Med. Coll., 1906 Salisbury

Dimmette, James A., Univ. of Louisville, 1905 Welbury, Ky.

Ezzell, Sam'l H., P. & S., Atlanta, 1900 VanWyck, S. C.

Elias, Lewis W., P. & S., N. Y., 1903 Asheville

Farthing, Logan E., Univ. of K C, 1906 Boone

Fenner, Edwin L., Univ. of Md., 1906.

Fleming, Major I., Jeff. Med. Coll., 1^6 Hamilton

Grantham, Wilmer L., N. C. Med. CcmIoOO McDonald

*Gaines, Lewis M., Johns Hopkins, 1906 Wake Forest

Harper, James H., Jeff. Med. Coll., 1906 Snow Hill

Holshauser, Allen R., Chatanooga Med. Coll., 1904 Rockwell

Hodgin, Henry H., N. C. Med. Coll., 1906 Red Springs

Hodges, James M., Balto. Med. Coll., 1904 Banner Elk

Hunter, Wm. Myers, Georgetown Univ., D. C, 1905 Charlotte

Hull, Theo. Y., Coll. P. & S., N. Y., 1902 Asheville

Hoeutt, Battle A., Univ. of N. C, 1906 Wakefield

Hall, James F., Jeff. Med. Coll., 1904 Morganton

Haggard, John T., Univ. Coll. of Med., Va., 1906 Aulander

Jauney, Francis W., Univ. of Md., 1905 Baltimore, Md.

* Made highest grade.

940 APPENDIX.

Name and College of Graduation. Address at Time Licensed.

Jarboe, Jacob P., Georgetown Univ., D. C, 1905 Greensboro

Jones, Harry H., Univ. of N. C, 1906 Franklin

Jordan, Wm. S., Univ. of N. C, 1906 Raleigh

Kornegay, Lemuel W., N. C. Med. Coll., 1906 Mt. Olive

LaflFerty, Robert H., N. C. Med. Coll., 1906 Davidson

Lane, John L., N. C. Med. Coll., 1906 Faison

Long, Van McK., N. C. Med. Coll., 1906 Unionville

Leeper, Donald H., N. C. Med. Coll., 1906 Charlotte

Laphani, Mary E. (female). Woman's Med. Coll., Phila., 1900. Highlands

Lloyd', Reuben A. (col.), Meharry Med. Coll., 1904 Williamston

Moorfield, Rufus H., N. C. Med. Coll., 1906 Vade Mecum

Manville, W. E., Univ. of Md., 1906 Washington, D. C.

Morrison, Rufus R., N. C. Med. College, 1906 Shelby

Martin, Mary L., Woman's Med. Coll., Pa., 1906 Davidson

McCoy, Thos. M., N. C. Med. Coll., 1905 Huntersville

McLemore, Geo. A., Univ. of N. C, 1906 Parkersburg

Nisbet, Verner, Univ. of Pa., 1901 Philadelphia, Pa.

Newell, Hodge A., Balto. Coll. P. & S., 1906 Mapleville

Peeler, Clarence N., N. C. Med. Coll., 1906 Casar

Perkins, David R., Balto. Med. Coll., 1903 Marshville

Peete, Chas. H., Univ. of Va., 1903 Warrenton

Pritehard, John L., P. & S., Balto., 1906 Aulander

Perkins, Frank E., Univ. Buffalo, N. Y., 1905 Copenhagen, N. Y.

Patterson, Joseph F., Jeff. Med. Coll., 1906 New Bern

Parrott, Albert DeK., Univ. Coll. Med., Va., 1906 Kinston

Quiller, Emile B., Univ. of Md., 1906 Rocky Mount

Ringer, Paul H., Coll. P. & S., N. Y., 1904 Asheville

Rhodes, James S., Med. Coll. of Va., 1906 Williamston

Ruffin, Joseph B., Univ. of the South, 1898 Powellsville

Rose, Abraham F., Jeff. Med. Coll., 1906 Smithfield

Simmons, John O., Grant Univ., 1904 Dysartsville

Stone, Wesley M., N. C. Med. Coll., 1906 Davidson

Smith, Ezekiel E. (col.), Howard Univ., 1903 Fayetteville

Sheep, Wm. L., Geo. Wash. Univ., 1906 Washington, D. C.

Staneill, Wm. W., Univ. Coll. Med., 19l06 Margarettsville

Speight, Joseph P., Jeff. Med. Coll., 1906 Whitaker's

Taylor, Geo. W., N. C. Med. Coll., 1906 Laurel Springs

Tankersley, James Wm., Jeff. Med. Coll., 1906 Salisbury

Taylor, Emora A. (col.), Leonard Med. Coll., 1906 Bovina Miss.

Utley, Herbert H., Balto. Med. Coll., 1906 Cardenas

Vick, Geo. D., Jeff. Med. Coll., 1906 Selma

Williams, John W., Univ. of Md., 1906 Washington

Waddie, James C. (col.), Meharry Med. Coll., 1904 Greensboro

Wilcox, Jesse W., Univ. of N. C, 1906 Putnam

Wilkerson, Chas. B., Univ. of N. C Durham

Yow, Iva A., N. C. Med. Coll., 1906 Sprite

York, Hugh B., Univ. Balto., 1906 Williamston

N. C. MEDICAL SOCIETY. 94:1

46th session— June, 1907, Morehead City.

(Membois of board present: Drs. A. A. Kent, M. H. Fletcher, James
M. Parrolt, Chas. O'H. Laughinghou:-e, J. T. J. Battle, Frank H. Rus-
sell and G. T. Sikes.)

Name and College of Graduation. Address at Time Licensed.

Alexander, Emory Graham, Jeff. Med. Coll., 1904 Charlotte

Austin, Fred. D., N. C. Med. Coll., 1907 Charlotte

Anderson, James G., Univ. of N. C, 1906 Asheville

Adkins, Elma H., Univ. Md., 1905 Southport

Brittle, Paul C, Univ. Coll. Med., Va., 1907 Woodland

Buekner, Rufus G., Arkansas Univ., 1897 Asheville

Boyd, Lois (female), Woman's Med. Coll. of Balto., 1907. Barium Springs

Bruce, Wm. H. (col.), Leonard Med. Coll., 1907 Henderson

Bebee, Wm. Thos. (col), Howard Univ., 1906 Washington

Bitting, Numa Duncan, Jeff. Med. Coll., 1907 Rural Hall

Baggett, Seaman, N. C. Med. Coll., 1907 Dunn, Va.

Best, Henry B., Univ. of N. C, 1907 Wilson

Bass, Spencer P., Univ. of Va., 1906 Tarboro

Barefoot, Julius J., Univ. of N. C, 1907 Wilson

Biggs, Montgomery H., Univ. of Pa., 1897 Hinsdale, 111.

Crowson, Samuel 1., Univ. of Tenn., 1903 Statesville

Grumpier, Paul, Univ. of Tenn., 1907 Clinton

Cox, Thos. H., Univ. of Md., 1885 Hertford

Capehart, Lovelace Brown (col.), Leonard Med. Coll., 1907. .. .Raleigh

Currie, Edward Womack, N. C. Med. Coll., 1907 Davidson

Coleman, Geo. S., Med. Coll. of Va Elizabeth City

Clifford, John S., Geo. Wash. Univ., 1906 Charlotte

Duffy, Richard, Johns Hopkins, 1906 New Bern

Duncan, Julius E., Univ. Coll. of Med., Va., 1907 Moravian Falls

Drum, Elam A., Univ. Coll. Med., Va., 1907 Richmond, Va.

Dowd, John Alex., N. C. Med. Coll., 1902 Eagle Springs

Dees, Pv. 0., Univ. of Md., 1906 Grantsboro

Dick, Julius Vance, Univ. of N. C, 1907 Whitsett

Edwards, A. W., Coll. P. & S., Atlanta, 1907 Gilkey

Easley, Henry 0., Univ. of Va., 1904 Boardman

Easley, Philip S., N. C. Med. Coll., 1907 Black Walnut, Va.

Eckel, O. F., Med. Coll. of S. C, 1907 Edenburg, 111.

Floyd, James W., Med. Coll. of S. C, 1900 Liberty Hill. S. C.

Flowers, Clarence A., Coll. P. & S., Balto., 1905 Cashsomer

Frizzelle, Mark T., Univ. Coll. Med., Va., 1907 Snow Hill

Fisher, Hunter W. (col.), Leonard Med. Coll., 1907 Beaufort

Ferrell, John A., Univ. of N. C, 1902 Clinton

Gaylord, Cavassa J. Hubert (col.), Leonard Med. Coll., 1905. .. .Ropier

Grayson, Chas. Shober, Geo. Wash. Univ., D. C, 1906 High Point

Guin, Lemuel Edwin, N. C. Med. Coll., 1907 Unionville

Gray, Eugene Price, Johns Hopkins, 1905 Winston-Salem

Harris, Arthur Graham, Univ. of South, 1905 Fairfield

942 APPENDIX,

J^'ame and College of Graduation. Address at Time Licensed.

Harrell, Geo. Norfleet, Univ. Coll. Med., Va., 1907 Potecasi.

Haggard, Wm. Alden, Univ. Coll. Med., Va., 1907 Windsor

Harper, Clifton G., Univ. Coll. of Med., Va., 1907 Menola

Hand, Edgar Hall, N. C. Med. Coll., 1907 Lowell

Hudson, John H., Coll. P. & S., Balto., 1907 Wrightsville

Holliday, Robert Sumner (col.), Leonard Med. Coll., 1905. .Fayetteville
Hennill, Mitchell Harvey, Eclectic Med. Institute, 0., 1891 .Coshocton, 0.

Howe, Wm. B. W. Jr., Med. Coll. of S. C, 1906 Spartanburg

Hood, John Sidney, Jeff. Med. Coll., 1907 Charlotte

Hyatt, Houston Boyd, Univ. of Md., 1907 Clinton

Hyatt, Fred C, Jeff. Med. Coll., 1907 Waynesville

Ivey, Emmett W. Gibbs, Univ. of N. C, 1907.

Hobgood, James E., Jeff. Med. Coll., 1907 Oxford

Justice, Gaston B., Coll. P. & S., Atlanta, 1907 Marion

Jackson, Nathaniel (col.), Leonard Med. Coll., 1907 Carthage

Knox, John Jr., Univ. of Md., 1906 Lumberton

*Lineback, Eobert Fred, Univ. of Pa., 1907 Winston-Salem

Lynch, James M., Geo. Wash. Univ., D. C, 1905. .. .National Soldiers

Hame, Va.

Mayerburg, Israel W., Univ. of Pa., 1907 Goldsboro

Moore, Chas. Edward, Jeff. Med. Coll., 1907 Moore's Springs

Moore, Henry Spencer (col.), Leonard Med. Coll., 1907 New Bern

Mills, Joseph Napoleon (col.), Leonard Med. Coll., 1907. .. .Wilmington

Mann, Wm. (col.), Leonard Med. Coll., 1905 Hertford

Matthews, John Herbert, N. C. Med. Coll., 1907 Mt. Pleasant

Moore, James Claude, Univ. Coll. of Med., Va., 1907 Globe

Mitchell, Paul Henry, Univ. Coll. of Med., Va., 1907 Ahoskie

Merritt, John Hamlet, Univ. of N. C, 1906 Roxboro

McLean, Peter, Univ. of Md., 1906 Laurinburg

Mcintosh, Donald M., Med. Coll. of Va., 1904 Old Fort

McDonald, Augustus Alex., N. C. Med. Coll., 1905 Pinehurst

McDonald, William W., Vanderbilt Univ., 1905 Pee Dee

Norris, Henry, Univ. of Pa., 1908 Rutherfordton

Nesbit, Chas. T., Balto. Med. Coll., 1903 Wilmington

Noble, Robert P., Univ. of N. C, 1907 Selma

Nichols, Asbury Sullivan, Tenn. Med. Coll., 1906 Sylva

Olive, Wm. Wade, Univ. of Md., 1906 Apex

Ohlinger, Larrin B., West Penn. Med. Coll., 1900 Balsam

Olive, Percy Wingate, Balto.. Coll. P. & S., 1907 Apex

Packard, F. S., Med. School of Maine, 1887 Warrenton

Powell, Eppie Clifton, Univ. of Nashville, 1907 Auburn

Parker, Fied Marshall West Durham

Peterson, Chas. A., N. C. Med. Coll., 1907 Relief

Perry, Ernest Monroe, Coll. P. & S., Balto 1907 Louisburg

Price, Killian A., Univ. of Va., 1907 Gilbert, S. C.

* Made highest grade.

N. C. MEDICAL SOCIETY. 943

Name and College of Graduation. Address at Time Licensed.

Powers, John Brewer, Coll. P. & S., N. Y., 1907 Wake Forest

Querry, Eichard C, Univ. Coll. Med., Va., 1907 Huntersville

Robinson, W. James, Univ. Med. Coll., Va., 1904 Carter, Tenn.

Eoss, John K., Jeff. Med. Coll., 1907 Charlotte

Ehyne, Eobert E., N. C. Med. Coll., 1907 Gastonia

Eoberts, Peter Franklin (col.), Leonard Med. Coll., 1907.. West Raleigh

Eeid, John Franklin Concord

Slociini, Eobert B., Johns Hopkins, 1905 Wilmington

Stovall, Arnold, Med.-Chi., Phila., 1904 Madison, Ga.

Smart, Joseph B., Grant Univ., 1900 Ellenboro

Smith, Slade Alvah, N, C. Med. Coll., 1907 Elkton

Smith, William Hopton, Univ., Pa., 1906 Goldsboro

Toulon Alfred Joseph, Med.-Chi., Phila., 1906 Whittier

Thurber, Austin H. (col.), Leonard Med. Coll., 1907 Wilmington

Turner, Henry Gray, Univ. of Penn., 1906 Ealeigh

Taylor, James E., Univ. Coll. Med., Va., 1907 Kinston

Upchurch, Garey J., Univ. of Md., 1906 Apex

Watkins, Finsa B., Jeff. Med. Coll., 1907 Eutherfordton

Willingham, Benj. Jos., Med. Coll. of Va., 1906 Hope Mills

Wood, Ivey A., Univ. of N. C, 1907 Eyland

Warren, John Waddell, Univ. Coll. Med., Va., 1907 Edenton

Wallace, John W., N. C. Med. Coll., 1907 Huntersville

Woodard, Albert G., Univ. of N. C, 1907 Princeton

Wilson, Joshua H. (col.), Meharry Med. Coll., 1905 Florence, S. C.

Woolsey, Thos. H., Univ. of Tenn., 1900 Greenville, Tenn.

York, Alex. Arthur, Chattanooga Med. Coll., 1907 Linwood

47TII SESSION— June, 1908, Winston-Salem.

(Members of the board present: Drs. A. A. Kent, G. T. Sikes, J. T. J.
Battle, M. H. Fletcher, Chas. J. O'H. Laughinghouse, F. H. Eussell,
and James M. Parrott. )

Bolle, Chas. P., Univ. of Va., 1897 Wilmington

Avent, Frank W. (col.), Leonard Med. Coll., 1908 New Bern

Bizzell, Thos. Malcomb, Univ. of Md., 1908 Jason

Baird, John Wm., Tenn. Med. Coll., 1901 Mars Hill

Berry, John, Jeff. Med. Coll., 1908 Chapel Hill

Baird, David E., Balto. Med. Coll., 1906 Saginaw

Burns, Arthur B., Atlanta Med. Coll., 1908 Waynesville, Ga.

Bissell, Helen W. (female). Woman's Med. Coll., N. Y., 1879,

Rochester, N. Y.

Brown, V. J., Tenn. Med. Coll., 1905 Ogden, Tenn.

Bingham, Eobert Knox, Univ. of Tenn., 1905 Statesville

Carr, Eansom Lee, Balto. Med. Coll., 1907 Wallace

Choate, B. O., Med. Coll. of Va., 1908 Sparta

Covington, Piatt Walker, Univ. of Md., 1908 . . .Eockingham

Chaney, Thos. Morris, Univ. of Md., 1896 Old Fort

94i APPENDIX.

Name and College of Graduation. Address at Time Licensed.

Carter, Edward E. (col.), Leonard Med. Coll., 1908 Winston

Dees, Ralph E., Univ. of Md., 1900 Grantsboro

Dodds, Solon Arthur, Johns Hopkins, 1908 Salisbury

Edwards, S. R., Univ. of Md., 1908 Siler City

Engel, Wm. Royal, Jeflf. Med. Coll., 190G Tryon

Erwin, Herbert Jones (col.), Leonard Med. Coll., 1908 Morganton

Freeman, Robert Herman, Jeff. Med. Coll., 1908 Wake Forest

Frazier, H. T., Coll. P. & S., N. Y., 1901 Asheville

Fisher, Chas S. (col.), Leonard Med. Coll., 1908 Raleigh

Gardener, Garrett Dewey, Tenn. Med. Coll., 1908 Ivy

Garrenton, Cecil, Med. Coll. of Va., 1908 Shiloh

Green, Wm. Willis, Univ. of N. C, 1908 Franklinton

Honnicutt, Wm. Joseph, Univ. of Tenn., 1895 Asheville

Harris, David Watson, Univ. of N. C, 1908 Fayetteville

Henry, John Robert (col.), Leonard Med. Coll., 1908 Beaufort

Hudgett, W. C, Md. Med. Coll., 1903 Southern Pines

James, Wm. Daniel, Jeff. Med. Coll., 1908 Laurinburg

Jett, S. J., Univ. of South, 1903 Reidsville

Irwin, Haner Carson, Univ. of Md., 190o Charlotte

Kerr, John D. Jr., Univ. of Md., 1908 Clinton

Johnson, Wm. Alex., N. C. Med. Coll., 1907 Mt. Airy

Johnson, Wingate H., Jeff. Med. Coll., 1908 Raleigh

Lawrence, Chas. S., Geo. Wash. Univ., 1908 Mt. Airy

Lane, Paul P., , 1908 Wilson

Lassater, Edgar W., Univ. Coll. of Med., 1908 Rich Square

Ledbetter, Penlie B., Jeff. Med. Coll., 1908 Pisgah Forest

*Kitchin, Thurman D., Jeff. Med. Coll., 1908 Scotland Neck

Maynard, Julian Decatur, Univ. of N. C, 1908 Chapel Hill

Matkins, J. Marion, Univ. of Tenn., 1908 Mclver

Mock, Frank L., K C. Med. Coll., 1908 Winston-Salem

Mann, James E., Univ. of Md., 1907 Fairfield

Mebane, Wm. Nelson, Geo. Wash. Univ., 1908 Hillsboro

Mitchell, Laurence S. (col.), Leonard Med. Coll., 1908 Ahoskie

Monk, Geo. Monroe, Univ. of N. C, 1908 Raleigh

McPherson, Robert Gray, Univ. of N. C, 1908 Snow Camp

McLean, Allen, Univ. of Md., 1908 Laurinburg

Mclver, Evander McNair, Univ. Coll. Med., 1908 Jonesboro

McCotter, St. Elmo, Atlanta P. & S., 1908 Rayboro

*McConnell, John W., Univ. of Md., 1907 McConnellsville

McKee, John S., Univ. of Md., 1907 Raleigh

McMurry, Henry Embra, N. C. Med. Coll., 1908 Sharon, S. C.

Norris, Philip, Univ. of Pa., 1903 Rutherfordton

Nichols, Austin Flint, Univ. of N. C, 1908 Mt. Tirzah

Page, Frank Tho. (col.), Leonard Med. Coll., 1908 Durham

Pate, Fred James, Univ. of Md., 1908 Gibson

* Made highest grade— a tie.

N. C. MEDICAL SOCIETY. 045

Name and College of Graduation. Address at Time Licensed.

Powell, Jesse A,, Coll. P. & S., Balto., 1907 Hanellsville

Pepper, John Kerr, Coll, P. & S., Balto., 1907 Kernersville

Perry, Argo Hilliard, Md. Med. Coll., 1907 Rolesville

Potts, Robert M., Univ. of Md., 189G Lancaster, S. C.

Perry, Matthew N. L. (col.), Leonard Med. Coll., 1908 Fayetteville

Portis, Edgar S. (col.), Leonard Med. Coll., 1908 Louisburg

Reid, James \Vm , 1908 Lowell

Rich, John Calvin, Univ. of Nashville, 1908 Dellwood

Royster, Thog. Hays, Univ. Coll. Med., 1908 Oxford

Robertson, Wilbur B., Balto. Med. Coll., 1908 Burnsville

Ray, Alex. Hamilton (col.), Leonard Med. Coll., 1908 Raleigh

Rucker, Adin Adam, Univ. of Md., 1908 Rutherfordton

Smith, H. T., Med, Coll, of Va., 1908 Anna

Ross, Geo, Floyd, Univ, of Pa., 1907 Greensboro

Smith, John McNeil, Jeff. Med. Coll., 1908 Laurinburg

Smith, Thos. Harlie, Jeff. Med. Coll., 1908 Liberty

Smith, J. T., Atlanta P, & S., 1908 Salisbury

Shepherd, F, A„ Univ. of Tenn., 1908 Liberty

Spoon, Arthur O., Univ. of N. C, 1908 Oakdale

Stryon, Nathan Henry (col.), Leonard Med. Coll., 1908 New Bern

Shubert, Lewis Hecter, Tenn. Med. Coll., 1906 Enfield

Scoffield, E. J., Univ. of N. C, 1908 Waffinger's Falls, N. Y.

Stafford, Wm. Walter, Univ. Coll. Med., 1908 Elizabeth City

*Teirell, A, J., Univ, of N. C, 1908 Old Fort

Taylor, James Thos., Univ. of Md., 1908 Raleigh

Thornton, Frank J. (col.), Leonard Med. Coll., 1908 Raleigh

Timberlake, Richard E., Jeff. Med. Coll., 1908 Youngsville

Torrence, Wm. Green (col.), Leonard Med. Coll., 1907. .Huntsville, Ala,

Thori)ton, Irene (female), Woman's Med, Coll., 1908 Fayetteville

Upchurch, Robt. T., Jeff. Med. Coll., 1908 Apex

Webb, Samplet E., Univ. of N, C, 1908 Brown's Summit

Winslow, C. F., Univ. of Md., 1908 Hobbsville

Whitesides, Geo. Wash., Univ. of Nashville, 1908 Uree

Whitley, A. H. D., Balto. Med. Coll., 1908 Monroe

Woodard, Wm. Tilson, Univ. of N. C, 1907 Democrat

Walters, Chas. Manly, Univ. of Md., 1908 Burlington

Watson, John Floyd 1908 Raleigh

Wichner, Wm. Arthur (col.), Leonard Med. Coll., 1908 Raleigh

Winstead, Geo. Lee (col.), Leonard Med. Coll., 1908 Rocky Mount

Watkins, Fred Henry (col.), Leonard Med. Coll., 1908 Wadesboro

Wakefield, H. A., N. C. Med. Coll., 1908 Charlotte

Wilson, Walter P., N. C. Med. Coll., 1908 Sandy Ridge

Ward, Vernon Albert, Jeff. Med. Coll., 1908 ". Wilson

Wellborn, Wm. R., N. C. Med. Coll., 1905 Coleridge

Wilkerson, Chas. E., Univ. of Nashville, 1907 Greensboro

Young, C, R., Univ. Med, Coll,, 1908 Angler

• Made hiffhest grade— a tie.

94-0 APPENDIX.

The following was received too late to be inserted under
i^Teerology. The rest of the book was in type and the proof
corrected.

The CuMBEiiLAxi) Coukty Medical Society,

Fayetteville, N. C, Feb. 18, 1909.
Dr. D. a. Stanton, Hecretary, High Point, N. G.

Dear Doctor: — Enclosed I hand you a memorial of Dr. T. D. Haigh,
written in July, 1908, by Col. C. W. Broadfoot, and adopted at the
February meeting of the Cumberland County Medical Society as the
memorial of the society to be placed on the minutes, a copy to be trans-
mitted to you for publication in the proceedings of the State Society
for I90S.

Yours fraternally, Wm. S. Jordan,

Secretary.

IN MEMORIAM.

Day by day we j^ass a house with closed doors and drawn shutters.
All is quiet and gloomy within its threshold. A Jessamineoides, clam-
bering ujjon the jjiazza blooming far beyond its season, still shows a
few fragrant pure-white flowers, as if to tempt the hand that trained it
back with its tender touch.

White flowers — emblematic of him who bore "the white flower of a
blameless life." All HaJ^nouuters know, that this was the home of
Dr. Thomas Devereaux Haigh, third son of Chas. T. Haigh and wife,
Sarah, born Crother,— born September 27, 1829, died March 23, 1908.
Married Eebecca S. McEae December 28, 1852.

His whole life of nearly four score years was spent in Fayetteville,
for surely his was a life of service. If asked to name his motto we
should say offhand, that English-like, — it was that of the head of his
race. King Edward VII,— "I serve." But a moment's reflection would
tell me to write upon his escutcheon only one word, the keynote of his
life, — DUTY. This was his inspiration, to do his duty, and his duty
was to serve. His God first, next his family with a husband's love, a
father's care; then his country, his friends always at all times, his
patients with a devotion seldom equaled, never surpassed ; then all about
him, kindly courteously, generously.

The writer knew Dr. Haigh for half a century and feels his is not the
pen to write his eulogy. He was too close to him. Owes to his skill
as surgeon and physician the better part of his life: or rather owes to
the watchful ej-e, the cool judgment, and more than all, sympathy
under suffering, something we have felt but can not describe, of this
good doctor — life itself. Many a poor woman, who has had him
beside her bed for hours on the stretch, will know what we mean, and
sav, Amen !

IX MEMOEIAM DE. T. D. IIAIGII. 947

Dr. Haigh had all the honors his profession in the State could give
him, but his reputation will rest securely upon the work he did and
the good opinion he won among those he visited, as a plain country
doctor. We make bold to hold him up to his professional brethren
of to-day as an exemplar worthy to be followed. His very presence in
the sick-room was inspiring, his manners easy, winning, cordial, friendly;
his questions few, pointed, but in language most refined; his eye search-
ing: his touch gentle as a Avoman's; his words guardedly measured,
weighed in golden balances, hopeful always; his face bright if possible,
if not, then trustful, hopeful, calm. He never left a sick-bed without
a word or look of cheer, if his conscience and judgment would allow.
The late Peter M. Hale, with an incurable disease, "came home to die
under Dr. Haigh's hands.'" The tenderness shown by these strong, able
noble men, lifelong friends, classmates at college and school, toward
each other was touching in the extreme.

Dr. Haigh kept up with his books, tried all that was new, which his
judgment approved, and stood fast by the old remedies and traditions
of the fathers. When called to a patient, he held sacred all that passed
in that patienfs home, and never talked indiscreetly about his cases.
Nothing ever leaked out from him. He carried to his grave many a
family secret. We commend, without offense, this control of tlie
tongue to his successors.

Why multiply words about the professional life of Dr. Haigh ? He
stood for all that was highest, best, most honorable in his profession.

We have played chess with him for liours, and recall with pleasure
his keen interest in the game and his nice sense of the proprieties of the
board. He enjoyed the game, not the victory.

We served as a private under him, when upon an emergency for a
short time he laid aside his i)rofession and with belted sword as captain,
commanded the Clarendon Guards, at Fort Fisher, a company made up
of judges, doctors, lawyers, merchants, preachers, and boys. The sur-
vivors of that mixed company will tell you to-day how his good sense
and good temper made him a splendid officer.

Dr. Haigh was one of the few — alas, how very few! — who set proper
value upon the social duties of life, and did them, of course. He made
it a point to call upon strangers, go to weddings, to all gatherings of
his friends, to funerals, and was found ahvays, Deo volente, up to the
week of his death, at church. He learned and put in practice the lesson
hard to most of us, of how to grow old gracefully, graciously; and
never lost interest in those about him. He was never so happy as
when surrounded by children and grandchildren under his own roof-tree.

A grand old man is gone out from amongst us. Let us take to heart
the lesson of his life. Duty — first, last, all the time, — duty cheerfully,
politely, honestly, honorably done.

In common with his fellow-citizens, we admired his talent^, liis high
character, his many good qualities.

948

APPENDIX.

We will each and all recall him as "one who bore without reproach
the grand old name of gentleman." But the writer prized most highly
his friendship. A month or so before he died, he brought to our office
and read to us a beautiful piece of poetry, entitled "The Answer of the
Leaves " — said his thoughts had been attracted to the falling leaves
blown hither and thither by the winds. And he had put them into
verse. We asked him to publish the verses. He said no. He wanted
to read it to Myrover and myself only. The original lies before us, and
we can not resist the temptation to quote the last stanza:

"For there's nothing that dies but a germ does entwine
That surely will blossom with glory divine.
It will come in its glory to you and to me
The beautiful flower, from the leaf on the tree."

His heart was surely fixed "where true joys are to be found." When
we think of our friend, gone before, again and again the lines from
Jerusalem the Golden come to us:

"There from care released,
The shout of them that triumph,
The song of them that feast."

INDEX.

PAGE.

Abernethy, Dr. C. 0 18, 35, 182. 776

Abernathy, Dr. C. O.: "Adrenalin Chloride: Its Uses in Medicine," 776

Abscess of Brain Dr. R. G. Buckner ^ 567

Acetanilid Poisoning, Dr. H. H. Kapp 780

Address of Welcome, Hon. O. B. Eaton, Mayor of Winston, 21, 40 to 46
Address of Welcome, Response to. Dr. Chas. L. Pridgeon. . 21, 47 to 49
Address, the President's Annual — "Random Notes on the History,
Aims and Purposes of the Medical Society of the State of North

Carolina," Dr. J. Howell Way 21, 22, 177, 251

Address Report of Committee on President's 177, 178

Aerostatic Deafness, Dr. W. Perry Reaves o84

Adjournment 38, 173, 174

Amblyopia, Toxic Forms Due to Abuse of Alcohol, etc.. Dr. J. H.

Honnett 789

American Medical Association, Our Relations to 256, 267 to 269

American Medical Association, Members Elected to House of Dele-
gates 165

Amendments to Constitution proposed. Dr. Jno. T. Burrus 193, 194

Amendments to Constitution proposed, Dr. A. A. Kent 194

Anesthetics, Local, in Surgery, Dr. John A. Williams 540

Anderson Dr. Thos. E 24, 71, 74, 548

Anderson, Dr. Thos. E., "Carbuncle— Its Etiology, Pathology, etc..

With a Treatment Commended" 548

Anderson, Dr. Albert 17, 27, 33. 84, 165, 182, 477

Anderson, Dr. Albert, "The Examiner's Golden Rules for Life In-
surance Work" 477

Annual Essay: "The Lines of Progress in the Practice of Medicine"

Dr. Thos. R. Little 284

Annual Oration: "The Physician and Education," Dr. Chas. S. Mar-
gum 2(8

Anemia in the White Race, the Influence of the Negro Upon, Dr.

Chas. W. Stiles 325

Anti-rabic Treatment Administered by State Board of Health 214

Alcoholics, Prescribing as Beverages, resolutions ofl"ered by Drs. J.

Howell Way and Chas. J. O'H. Laughinghouse 160 105

Antitoxin, A Word for in Diphtheria, Dr. E. M. Hutchins 729

Alamance County Society 185. SH

Anson County Society 185, 845

Alexander-Iredell County Society 188, 8G9

Ashe County Society 845

Akerman, Dr. Joseph 24

950 INDEX.

PAGE.

Appeals from the President's rulings 27, SO, SI 'J3, !)4

Applegate, Dr. W. A 20, 37

Appendicitis, Plea for Early Operations in, Dr. J. F. Highsmith.. .50i

Appendicostomy in Amcebic Dysentery, Dr. Brodie C. Nalle 537

Archer, Dr. I. J 17

Arthritis, Influenzal, Dr. J. J. Philips Uj4, 608

Asheville, Place of Meeting in 1909 165

Association, Xorth Carolina for the Prevention of Tuberculosis 212

Association, American Medical, Members House of Delegates

elected 1(]5, 193

Association, Mississippi Valley Medical, delegates elected to. . . 165, 193

Artificial Food Suitable for Young Infants, Dr. Chas. Roberson .... ()92
Artificial Interruption of Circulation a Therapeutic Measure, Dr. E.

T. Dickinson 725

Averitt, Dr. K. G 26, 77, 18G

Albuminuria Relieved by Hydrastis, Dr. Francis Dulfy 763

Albuminuria Treated with Hydrastis Dr. Richard H^. DuiFy 771

Beaufort County Societj- 185, 846

Bertie County Society 185

Bladen County Society 185, 847

Burke County Society 847

Brunswick County Society 186, 850

Buncombe County Society 186, 848

Battle, Dr. Kemp P 182

Banquet 106

Battle, Dr. J. T. J 20, 30, 37, 113, 196, 199

Battle, Dr. J. T. J., Examination in Physiology and Hygiene 199

Bahnson Dr. Henry T., 25, 30, 31, 76, 116, 117, 149, 152, 153, 154, 231
Bahnson, Dr. Henry T., motion relative to Charlotte ^Medical Jour-
nal 152, 154

Bahnson, Dr. Henry T., personal privilege 118, 119

Bahnson, Dr. Henry T., Memorial to Dr. Joseph C4raliam. . . 25, 70, 231

Beall, Dr. J. F., Obituary 245

Beam Dr. J. L., Obituary 248

Beall, Dr. W. P 30, 145, 146, 147

Beall, Dr. W. P., lemarks in re Guilford County Society matter,

145 to 147

Blair, Dr. J. M 92, 165, 190

Bladder, Stone in the. Report of Case, Dr. .James M. Parrott 603

Bolton, Dr. Mahlon 23, 58, 59, 60, 191

Bolton, Dr. Mahlon, remarks on Hernia 58 to 60

Board of Medical Examiners, election of new Board 80 to 95

Board of Medical Examiners, Proceedings of 1908 Session, 196 to 211

Board of Health, Proceedings of, etc 213 to 217

Board of Health, Conjoint Session with Society 90 to 105

INDEX. 961

PAGE.
Board of Health announces establishing of Anti-rabic Institute. . . . 213

Booth, Dr. Samuel D 27, 81, 88, 182, 184, 187, 188

Booth, Dr. Samuel D., remarks as to illegal doctors 188

Boone, Dr. W. H I'J. 35, 757

Boone, Dr. W. H. : '"Therapeutics an Art" 757

Bright" s Disease, Hydrastis in Treatment of, Dr. Francis Duffy. . . . 763
Bright's Disease Simulated by Myxcedema, Hydrastis in, Dr. Kicli-

ard N. Duffy "'1

Brooks, Dr. J. E 17, 27, 32, 89, lUl, 1G3, 403

Brooks, Dr. J. E.: "Some of the Essentials in the Treatment of

Moderatel}^ Advanced Tuberculosis'" 403

Brown, Dr. J. Stevens 19, 31), 098

Brown, Dr. J. Stevens: "Scarlatiniform Eruptions"' 698

Brown, Rev. H. A., opening invocation 21, 39

Bonner, Dr. Kemp P. B 24, 597

Bonner, Dr. Kemp P. B. : "An Interesting Case of Gangrene"' 597

Briggs, Dr. H. H 18, 33, 34

Brawley, Dr. R. V 190

Brown, Dr. Thos. E. VV 31, 170, 192, 374

Brown, Dr. Thos. E. W.: "The Relation of the Surgeon to tlie Gen-
eral Practitioner" 374

Bryant, Dr. C. G 18, 33

Buchanan, Dr. J. E 186

Burns, Dr. W. :\r 186

Burroughs, Dr. .James A 22, 23, 28, 67, 92, 99, 177, 191

Buckner, Dr. R. G 24, 567

Buckner, Dr. R. G. : "Abscess of the Brain" 567

Burrus, Dr. John T 23, 67, '69, 90, 93, 150, 154, 193, 194, 614

Burrus, Dr. John T., offers amendment to Constitution 193, 194

Burrus, Dr. .John T. : "Empyema: Etiology, Symptoms, Treatment,

and When to Do Thoracotomy, with Reports of Cases"' 014

Bullock, Dr. D. W., elected Honorary Fellow 194

Butler, Dr. Tait 28, 29, 100, 212, 235

Butler, Dr. Tait: "Our ]\Iilk Supply and Some of Its Relations to

Public Health" 235

Bynum, Dr. .John T 27, 88, 94, 95, 105. 208

Bynuni, Dr. .John T., elected member of the State Boaid of Medical

Examiners 27, 88, 94

County Societies represented in House of Delegates 175 to 177

County Societies, reports from 185 to ] 91

Catawba County Society 852

Carteret County Society 180, 852

Cabarrus County Society 186, 850

Caldwell County Society 186, 851

Caswell Countv Societv 1 86, S52

952 INDEX.

PAGE.

Chatham County Society 186, 853

Cumberland County Society 186, 855, 946

Craven County Society 186, 854

Cleveland County Society 853

Cherokee County Society 853

Columbus County Society 854

Currituck County Society 856

Cases, Recent Surgical, Dr. Joseph Graham 511

Capehart, Dr. Wm. R., Obituary 249

Councilors at Winston-Salem Session 175

Councilor, absence of, ruling by President on 119

Councilor, removal of, ruling by President on 182

Council, Reports of 182, 183, 184, 185

Council, Guilford County matters referred to by President, 30, 114, 118

Council, vacancies in filled pro tern by President 118 to 120

Council, Proceedings of in Special Session 121 to 138, 140 to 149

Cobb, Dr. Wm. H. H., elected Honorary Fellow 194

Carbuncle, Etiology, Pathology, etc.. Dr. Thos. E. Anderson 548

Carroll, Dr. Robert S ." 17, 33

Cranmer, Dr. J. B 19, 27, 36, 89, 647

Cranmer, Dr. J. B. : "Hydatidiform Mole (Myxoma Chorii), with

Report of Case" 647

Croom, Dr. A. B 27, 31, 139, 170, 190, 353

Croom, Dr. A. B. : "Obstetric Work From the Standpoint of the

General Practitioner" 353

Charlotte Medical Journal 30, 31, 122, 123, 128, 143,

144, 149, 150, 151, 152, 153, L55, 156

Charlotte Medical Journal, resolutions relative to 123, 152, 154

Chairmen of Sections for 1909 Session 170

Children, Pneumonia in. Dr. J. A. Turner 705

Children, Pleurisy in. Dr. J. R. McCracken 710

Child-bearing, The Things That Kill Women in. Dr. H. D. Stewart, 624
Chondromata, With Report of a Case Undergoing Degeneration,

Dr. E. B. Glenn 552

Cholecystitis, Report of a Case of Typhoid, Dr. Wm. A. Graham. . . . 534

Coccygeetomy, Dr. John R. Irwin 668

Conscience, The Surgical, Dr. John C. Rodman 487

Constitution, amendments proposed. Dr. John T. Burrus 193, 194

Constitution, amendments proposed. Dr. A. A. Kent 194

Conservatism in Railway Surgery, Dr. W. P. Whittington 531

Coxa Vara, Dr. Wm. Moncure 720

Crowell, Dr. A. J 80, 87, 94, 165, 193

Crowell, Dr. A. J., elected to House of Delegates A. M. A 193

Crowell, Dr. L. A 23, 27, 68

Cooper, Dr. G. M 25, 76, 227

Cooper, Dr. G. M., Memorial to Dr. P. L. Murphy 227

INDEX. 963

PAGE.

Conjoint Session Society and State Board of Health 27, 9G

Contents 3, 4, 5

Committee to Examine Constitution 113

Committee on Nominations, Report of 191, 192, 193

Committee, Obituary, Report of 218

Committee on President's Address, Report of 177, 178

Committees for 1909 165, 193

Dalton, Dr. D. N 28, 105, 165

Dalton, Dr. D. N., invites Society to banquet in Nissen Park 105

Dalton, Dr. J. S , 165

Data, Historical, of Society 6, 7, 8

Data, Historical, of Board of Medical Examiners 9

Data, Historical, of State Board of Health 10

Data, Historical, of the Society and its affairs 251

Davidson County Society 186, 856

Davie County Society 186, 857

Debate, Leader of Elected for 1909 Session, Dr. L. B. Newell. . 165, 193

Delegates from County Societies 175, 176, 177

Delegates' Reports from County Societies 185 to 191

Delegates, House of. Proceedings 175 to 195

Delegates to Other Societies Named 165

Delegates, House of, Action on Resolutions Relative to Prescribing

Alcoholics as Beverages 166

Dees, Dr. Daniel A 32, 165, 189, 192, 436

Dees, Dr. Daniel A., Elected Vice-President of Society 192

Dees, Dr. Daniel A.: "Importance of Early Diagnosis in Successful

Treatment of Tubercular Affections" 436

Dees, Dr. R. 0 19, 35 672

Dees, Dr. R. O. : "Hysterectomy, With Report of a Case" 672

Deafness, Aerostatic, Dr. W. Perry Reaves 584

Dickinson, Dr. E. T 20, 27, 30, 37, 87, 120, 193, 725

Dickinson, Dr. E. T., "Artificial Interruption of the Physiological

Circulation as a Therapeutic Measure" 725

Dickinson, Dr. E, T., Elected Councilor 193

Disosway, Dr. R. J 165

Discussions:

Ligation of Femoral Artery 51 to 53

Orthopedic Surgery, A Plea for 53 to 56

Hernia 56 to 61

Mesenteric Thrombosis 61

The Surgical Conscience 64 to 67

Empyema and Thoracotomy 67 to 69

Hydrocele 69 to 70

Condition of Patient Influencing Operation Results 71

Carbuncle 7 1 to 75

954 INDEX.

Discussions — coutiuued. page.

Endo-Aneui-ismonhaphy 75 to 76

Memorial Services 70 to 80

Dr. Jolm Roy Williams' '-Personal Privilege" 81 to 82, 101

Election of Examining Board S3 to 95

Soil Pollution by Hook-worms Dti, 97

Milk Supplies and Tuberculosis as Related Thereto 97 to 101

Pellagra 101 to 105

Discussions at the Banquet, Winston Hospitality^ the Ladies,

Dr. Lewis's Fun-inaking, etc 100 to 111

Relations of Gynecology and Surgery ll.^

Apparent Discrepancy in Constitution W'A

Guilford County Society Resolutions 114 to 155

Results of Surgery as Seen in Practice 154, 155 to 161

Tuberculosis 161 to 163

Cholecystitis 164

Adjournment 173 to 174

Councilors, Their Duties and Expenses 183, 184, 185

County Societies, Their Work, etc 184 to 191

Resolutions Relative to Prescribing Alcoholics as Beverages,

165 to 167

Remarks of President Way on Retiring as President 167, 168

Remarks of President Highsmith on Being Installed President,

109, 170

Remarks by Dr. Knox Relative to Retiring President 168, 169

Proposition for Appointment of Committee Relative to State

Medical Journal 171, 174

Disease, Prevented by Outdoor Life, Dr. Paul Puquin 431

Diphtheria, Antitoxin, etc., Dr. E. M. Hutchens 729

Diagnosis, Importance of, in Early Tuberculosis, Dr. D. A. Dees .... 430

Diagnosis of Acute Miliaiy Tuberculosis, Dr. Silvio Von Ruck 406

Dodson, Dr. Henry H 27, 85, 90, 93, 95, 165, 193, 208

Dodson, Dr. Henry H., Elected Member of Board of INIedical Exam-
iners 27, 85, 93, 95

Duffy, Dr. Francis 17, 23, 27, 30, 33, 64, 83, 111, 763

Duffy, Dr. Francis: "Hydrastis Treatment of Brighfs Disease". . . . 763

Duffy, Dr. Richard N 33, 771

Duffy, Dr. Richard N. : "A Case of Myxoedema Simulating Bright"s
Disease, With Note on Treatment of Albuminuria by Hy-
drastis" 771

Duncan, Dr. G. F 19, 3(), 077

Duncan, Dr. G. F., ''Diagnosis and Treatment of Ectopic Gestation
from the Standpoint of a Country Physician, with Report of a

Case" 677

Dunn, Dr. Wm. L 32, 161, 162, 165, 193, 212

Dunn, Dr. Wm. L., Elected Annual Essayist for next Session. . 165, 193
Dunn, Dr. Wm. L., Elected President Anti-tuberculosis Association, 212

INDBX, 955

PAGE.

Durham County Society 858

Duplin County Society, Report from ISfS, 857

Drugs, Use and Abuse of in Tuberculosis, Dr. W. M. Jones 425

Eaton, Hon. O. B., Address of Welcome to Society 21. 40 to 46

Early Operation in Appendicitis, Dr. J. F. Higlismith 504

Eclampsia, Puerperal, Dr. E. F. Strickland 051

Eclampsia, Puerperal, Dr. John A. Ferrell 056

Excision of Coccyx, Dr. John R. Irwin 008

Ectopic Gestation, Dr. G. F. Duncan 077

Edgecombe County Society 859

Election Board of Medical Examiners 20, 205, SO to 95

Elections 27, SO to 95, 192, 193, 194

Enchondromata, Dr. Eugene B. Glenn 552

Endo-aneurismorrhaphy, Dr. Thos. M. Green 560

Entertainment of State Medical Society 28, 29, 105 to 111

Empyema, Thoracotomy for, etc.. Dr. John T. Burrus 014

Essay, The Annual: "The Lines of Progress in the Practice of Medi-
cine," Dr. Thos. R. Little 284

Essay, The Annual 18, 29, 107. 284

Essay, The Annual, Dr. W. L. Dunn Elected to Deliver in 1909 193

Essentials in Treatment of Moderately Advanced Tuberculosis, Dr.

J. E. Brooks 403

Expenses, Councilors and Legislative Committee 193

Examiners, State Board of ^Medical, Questions Used at Session, 190 to 199

Examiners, Record of Applicants and Colleges, etc 200 to 204

Examiners, Licentiates, Grades, etc 200 to 207

Examiners, Reciprocal Licentiates 207

Examiners, Jfew Board Elected SO to 95

Examiners, Xew Board Organized 208

Examiners, Laws and Regulations of 20S to 211

Examiners, List of from Organization in 1859 to 1908 9

Examiners, Licentiates of Board from 1859 to 1908 S9S to 945

Examiners, Highest Grades Made at Winston 205

Eruptions, Scarlatiniform, Dr. J. Stevens Brown 098

Faison, Dr. I. W 17, 32. 3.-.. 19-i

Faison, Dr. I. W., Elected Honorary Fellow 194

Ferrell, Dr. John A 19, 656

Ferrell, Dr. John A.: ''Puerperal Eclampsia, with Report of Cases," 656

Femoral Artery, Ligation of. Results, Dr. J. R. Paddison 556

Fletcher, Dr. M. H 30, 31, 113, 140, 190. 197

Fletcher, Dr. ;M. H., Examination on Practice of Medicine 197

Flippen, Dr. R. E. L 165

Flippen, Dr. S. T., Report from Surry County Society 190, 191

Fever, Treatment of Typhoid, Dr. T. C. Quiekel 462

95 G INDEX.

PAGE.

Food, Artificial, for Infants, Dr. Chas. Roberson 692

Fox, Dr. M. L 25, 72

Forsyth County Society ISO, 859

Franklin County Society 187, 800

Gangrene, Report of a Case of, Dr. K. P. B. Bonner 597

Garrison, Dr. D. A 18, 35, 165, 187, 192, 786

Garrison, Dr. D. A., Elected Vice-President 192

Garrison, Dr. D. A. : "Morphine and Kindred Drugs : Their Use and

Abuse" 786

General Condition of Patient as Influencing Result of Operation,

Dr. Stuart McGuire 491

General Practitioner, Importance of his Work, Dr. L. B. McBrayer, 295
General Practitioner, His Relation to Gynecology, Dr. J. E. Stokes, 315

General Practitioner, Laboratory for, Dr. Watson S. Rankin 348

General Practitioner, His Relation to Obstetrics, Dr. A. B. Croom, 353
General Practitioner, Relation to Ophthalmology, Dr. G. S. Tennent, 356
General Practitioner, The, as a Surgeon, Dr. Edmund Harrison. . . . 370
General Practitioner, Relation to the Surgeon, Dr. Thos. E. W.

Brown 374

George, Dr. D. S 165, 193

Glenn, Dr. Eugene B 26, 27, 80, 90, 92, 93, 552

Glenn, Dr. Eugene B. : "Chondromata, and Report of a Case Under-
going Malignant Degeneration" 552

Glenn, Dr. L. N 18, 35

Gilbert, Dr. J. S 165

Gibbs, Dr. N. M 186

Gibbon, Dr. Robert L., Report on Necrology 218

Gibbs, Dr. J. B 24

Golden Rules for Life Insurance Work, Dr. Albert Anderson. 477

Grady, Dr. Earle 165

Grady, Dr. J. C 20, 37, 735

Giady, Dr. J. C: "The Importance of a Thorough Knowledge of
Biology, Bacteriology, and the Circulation of the Blood for the

Successful Application of Serum Therapy" 735

Graham, Dr. B. R 19, 36, 620

Graham, Dr. B. R. : "Management of the Third Stage of Labor" 620

Graham, Dr. Joseph 31, 159, 511

Graham, Dr. Joseph: "A Few Recent Unique Surgical Cases" 511

Graham, Dr. William A 17, 33, 163, 534

Graham, Dr. William A.: "Report of a Case of Typhoid Cholecysti-
tis, Operation, Recovery" 534

Graham, Dr. Joseph, In Memoriam 25, 76, 219, 231, 233, 276

Graham, Dr. Joseph, a Tribute by His Friend, Dr. H. T. Bahnson,

231 to 233

INDEX. 957

PAGE.

Graham, Dr. Joseph, In Memoriam, Extract from Charlotte Ob-
server 233 to 240

Graham, Dr. Joseph, In Memoriam, Tribute to in President's Ad-
dress 276

Grayson, Dr. C. S 17, 32, 446

Grayson, Dr. C. S. : "Tuberculin Therapy" 446

Green, Dr. Thos. M '. 25, 75, 560

Green, Dr. Thos. M. : "Endo-aneurismorrhaphy" 560

Gaston County Society 187, 861

Gates County Society 187, 862

Graham County Society 862

Granville County Society 187, 862

Greene County Society 187, 862

Guilford County Society 187, 863, 864, 865

Guilford County Society, Resolutions of Relative to Charlotte Medi-
cal Journal 27, 30, 81, 93, 114 to 155

Gynecology as Related to General Practice, Dr. J. E. Stokes 315

Halifax County Society 187, 866

Haywood County Society 187, 867

Halford, Dr. J. W 187, 191

Haines, Dr. J. L 22, 53, 55, 94, 159, 160, 186

Haines, Dr. J. L., Discussion of Paper Read by 53, 55

Halsey, Dr. B. F 89, 91

Haigh, Dr. T. D., In Memoriam 76, 77, 78, 242, 276, 946

Haigh, Dr. T. D., In Memoriam, Remarks, Dr. J. H. Marsh 77

Haigh, Dr. T. D., In Memoriam, Remarks, Dr. K. G. Averitt 77

Haigh, Dr. T. D., In Memoriam, Remarks by Dr. A. S. Rose 78

Haigh, Dr. T. D., In Memoriam, Report of Committee on Obituaries, 242
Haigh, Dr. T. D., In Memoriam, Remarks by President Way in

Annual Address 276

Haigh, Dr. T. D., In Memoriam, Cumberland County Society 946

Hathcock, Dr. T. A 190

Harris, Dr. E. E 190

Harris, Dr. H. H 27, 88

Harrison, Dr. Edmund 24, 128, 147, 370

Harrison, Dr. Edmund: "The General Practitioner as a Surgeon".. 370

Harnett County Society 187, 866

Harper, Dr. Chas. T 19, 27, 30, 89, 90, 91, 94, 120, 128

Hays, Dr. Benj. K 20, 26, 27, 37, 79, 87, 93, 95, 208, 218

Hays, Dr. Benj. K., Elected Member State Board Medical Exam-
iners 87, 93, 95, 208

Heighway, Dr. S. C 19, 36, 165

Health, State Board of. Annual Session 213 to 217

Health, State Board of. Conjoint Session with Society 27, 96

Health, State Board of, Review, Historical, Dr. J. Howell Way, 273 to 275
Health, State Board of. Establishes "Pasteur" Treatment 212

958 INDEX.

PAGE.
Health, State Board of, Members from Organization, 1877, to 1908, 10

Health, Public, as Affected by Milk Supply, Dr. Tait Butler 335

Hernia. Inguinal, Practical Points in Management of, Dr. Pi. L.

Payne 518

Henly, Dr. S. A 190

Henderson-Polk County Society 187, 868

Hertford County Society 868

Hyde County Society 869

Hill, Dr. L. H., Elected Honorary Fellow 194

High.5mith, Dr. J. F 19, 30, 31, 33, 34, 35, 156, 157,

158, 164, 165, 192, 504

Highsmith, Dr. J. F., Elected President of State Society 192

Highsmith, Dr. J. F., Installed President of State Medical Society, 169
Highsmith, Dr. J. F. : "A Plea for Early Operation in Appendicitis

Where the Diagnosis is Obscure" 504

Hiatt, Dr. H. B 19, 661

Hiatt, Dr. H. B.: "Placenta Prsevia — Its Pathology and Treatment,'" 661
Highsmith, Dr. J. F., Appoints Chairmen of Sections for 1909 Ses-
sion 170

History of Society, etc.. President's Address 251 to 264

Honnett, Dr. J. H 18, 34, 789

Honnett, Dr. J. H. : "Early Eecognition and Treatment of Toxic

Amblyopia, as Caused by the Abuse of Alcohol and Tobacco". . . 789
Historical Data, Society, Examining Board, Health Board, etc.,

6, 7, 8, 9, 10
Honorary Fellows, Election of, Eecommended by President Way. . . . 275

Honorary Fellows, Elected at Winston 194

Honorary Fellows, List of 898

Holt, Dr. W. P 170

Holliday, Dr. E. H., Obituary of 242

Holmes, Dr. Lawrence Edward, Obituary of 244

Hodges, Dr. J. Allison 29, 31, 106, 156, 160, 363

Hodges, Dr. J. Allison, Eemarks at Banquet 29, 106

Hodges, Dr. J. Allison: "An Opinion as to the Ultimate Eesults Ob-
tained from Surgical in Comparison with Medical Treatment,

in Certain Ovarian Diseases and in all Ovarian Neuroses"" 363

Hook-Avorm, Soil Pollution in Eelation to, etc.. Dr. C. W. Stiles .... 325

Howard, Dr. Wm. T., Memorial by Mr. T. B. Kingsbury 240

Hutchens, Dr. E. M 20, 36, 729

Hutchens, Dr. E. M. : "Diphtheria, and a Word for Antitoxin" 729

Hunter, Dr. K C 18, 35

Hydatidiform Mole, History of a Case, Dr. J. M. Williams 645

Hydatidiform Mole (Myxoma Chorii), Eeport of a Case, Dr. J. B.

Cranmer 647

Hydrocele, Dr. E. G. Moore 528

INDEX. 959

PAGE.

Hydrastis Treatment of Brighfs Disease, Dr. Francis Dufly 763

Hydrastis Treatment of Albuminuria, Dr. Richard X. Duflt'y 771

Hysterectomy, Dr. K. 0. Dees G72

lehtliyolated Emulsion Comijound, Report of Cases Treated by it.

Dr. John Roy Williams 439

Ileo-eolitis, Dr. H. L. Monk 700

Influenzal Arthritis, Dr. J. J. Philips 608

Invitation to Society to Hold 1909 Session in Asheville 34

Invocation, Oldening, Rev. H. A. Brown 39

Insanity, Pellagrous, Dr. John MeCampbell 102, 377

Intoxicants, Resolutions as to Physicians Prescribing Adopted by

Society, Drs. Way and Laughinghouse 166

Insurance Examinations, Golden Rules of. Dr. Albert Anderson. . . . 477
Insurance Examinations, Fees for. Dr. D. A. Stanton's Report of

Secretary 179

Importance of Early Diagnosis in Tuberculosis, Dr. D. A. Dees 436

Iredell-Alexander County Society 188, 869

Irwin, Dr. John R 23, 668

Irwin, Dr. John R.: "Excision of tlie Coccyx (Coccygectomy) "" 668

Jackson County Society 188, 870

Jarboe, Dr. Parran 18, 35

Jewett, Dr. R. D 28, 37, 155, 171

Jewett, Di-. R. D., Extends Invitation to Society to Banquet 28

Jewett, Dr. R. D., Motion for Committee to Consider Advisability

of Establishing a State Journal of Medicine 37, 171 to 174

Johnston County Societj- 188, 870

Jones, Dr. W. M 20, 32, 37, 161, 425, 717

Jones, Dr. W. M. : ''Use and Abuse of Drugs in Tuberculosis' 425

Jones, Dr. W. M., and Turner, Dr. Jas. A.: ''Report of a Case of »

Pseudo-Leucocythffimia Infantum"' 717

Jordan, Dr. Charles S 31

Journal, Motion for Committee to Consider and Report on. . 37, 38, 171

Julian, Dr. Clias. A 20, '25, 26, 28, 37, 76, 87, 94, 96, 212, 218, 165

Julian, Dr. Chas. A., Report of Obituary Committee 218 to 250

Julian. Dr. Chas. A., Vice-President, Presides in Society 26, 80

Kapp, Dr. II. H 37, 780

Kapp, Dr. 11. H. : "Toxic Changes from Prolonged Use of Acctani-

lid" 780

Kent, Dr. Alfred A 17, 22, 30, 33, 51, 113, 164, 165,

186, 192, 193, 194, 198, 481

Kent, Dr. Alfred A. : "Reciprocity"' 481

Kent, Dr. Alfred A., Amendment Suggested to Constitution 194

Kent, Dr. Alfred A.. Examination on Obstetrics and Gvnecologv. . . 198

960 INDEX.

PAGE.

Kerner, Dr. Elias, Obituary 247

Kirk, Dr. Wm. R 17, 32, 1G5

Kitchin, Dr. Thurman D., Makes Highest Mark on Examination, 205, 944

Knox, Dr. A. W 25, 30, 34, 76, 80, 82, 116, 118, 119, 120,

121, 123, 125, 126, 127, 129, 130,
131, 133, 134, 135, 136, 137, 141,
144, 151, 154, 159, 168, 169, 171, 173

Knox, Dr. A. W., In Memoriam Dr. P. L. Murphy 25, 76

Knox, Dr. A. W., Councilor pro tern 120 to 155

Knox, Dr. A. T7., Eulogizes the Retiring President 168, 169

Labor, Management of the Third Stage of, Dr. B. R. Graham 620

Laboratory, Relation of to the General Practitioner, Dr. W. S.

Rankin 348

Laboratory, State to Make Examinations of Fteces, etc 97

Lamm, Dr. I. W 20, 37

Lane, Dr. J. L 186

Laws and Regulations Relative to Medical Practice in North Caro-
lina 209 to 212

Laughinghouse, Dr. Chas. J. O'Hagan.. 30, 129, 131, 132, 134, 135,

137, 141, 142, 143, 147, 148, 166, 197
Laughinghouse, Dr. Chas. J. O'Hagan, Examination on Surgery. . . . 197
Laughinghouse, Dr. Chas. J. O'Hagan, and Dr. J. Howell Way,

Resolution Relative to Prescribing of Alcoholics as Beverages, 166

Lavinder. Dr. C. L 24, 25, 28, 72, 75, 303

Lavinder, Dr. C. L. : "Pellagra-Etiology and Pathology" 303

Legislative Committee 12, 165, 193, 195

Legislative Committee, Proper Expenses of to be Paid 195

Leigh, Dr. Southgate 18, 35

Lenoir County Society 188, 871

Lewis, Dr. C. H., Obituary of 248

Lewis, Dr. H. W 189

Lewis, Dr. Richard H 25, 27, 28, 29, 76, 83, 91, 95, 96, 108,

109, 110, 111, 165, 184, 191, 193, 194
Lewis, Dr. Richard H., In Memoriam Dr. Patrick L. Murphy, 25, 76, 224
Lewis, Dr. Richard H., Report Secretary Sta'te Board of Health,

28, 96, 212 to 217
Lewis, Dr. Richard H., Stories Told by at Evening Entertainment,

29, 108 to 111

Lewis, Dr. Richard H., Elected Honorary Fellow 194

Little, Dr. Thos. R 18, 29, 89, 107, 284

Little, Dr. Thos. R., The Annual Essay: "The Lines of Progress in

the Practice of Medicine" 284

Lilly, Dr. J. M 24, 594

Lilly, Dr. J. M.: "The Importance of the Early Diagnosis and Treat-
ment of the Mastoid Complications of Middle Ear Disease" 594

Licentiates, State Board Medical Examiners, Session 1008.. 200 to 207
Licentiates, State Board Medical Examiners, 1859 to 1908. . 898 to 945

INDEX. 061

PAGE.

Lincoln County Society Igg 872

Lines of Progress in the Practice of Medicine, Dr. Thos. R. Little. . . 284

Local Anesthetics in Surgery, Dr. John A. Williams 540

Lockett, Dr. E. A 27 88

Lett, Dr. H. S ,' 165

Long, Dr. Geo. W., Eeport from Alamance County Society 185, 189

Long, Dr. Geo. W., Elected Honorary Fe'llow of the Society 194

Long, Dr. Henry F 31

Long, Dr. John W 23, 24, 27, 30, 61, 70, 153

Lyday, Dr. W. M 17^ 33_ 75I

Lyday, Dr. W. M.: "Venesection: Its Indications and Uses as a

Therapeutic Agent" 75 1

Malaria and Early Tuberculosis, Their Differentiation, Dr. Paul

Kinger 452

Malaria, Some Atypical Manifestations of, Dr. J. W. P. Smithwick, 456

Mann, Dr. J. A 188

Mann, Dr. J. J., Obituary of 248

Mangum, Dr. Chas. S 18, 29, 107, 278

Mangum, Dr. Chas. S., The Annual Oration: "The Physician and

Education" 278

Management of Third Stage of Labor, Dr. B. E. Graham 620

Maternal Nursing, Dr. W. W. McKenzie 686

Mastoid Complications of Middle Ear Disease, Dr. J. M. Lilly 594

Meadows, Dr. W. J ; 20 36

Merritt, Dr. J. H I7 33

Memorial Session of Society 25 76

Memorial, Dr. P. L. Murphy 25, 76, 77, 276

Memorial, Dr. Joseph Graham 25, 76, 231, 233, 276

Memorial, Dr. Thos. D. Haigh 25, 76, 78, 276, 242, 946

Minutes of Winston Session, Synopsis of 21 to 38

Medical Journalism in North Carolina 269 to 272

Medical Journal, State, Suggestion as to 171

Medical Influence of the Negro, etc.. Dr. C. W. Stiles 325

Meeting of 1909, Place and Time of 165.

Milk Sickness, Dr. J. A. Reagan 467

Milk Supplies in Relation to Public Health, Dr. Tait Butler, 28, 97, 335

Macon-Clay County Society 872

Martin County Society 872

Madison County Society 872

Mecklenburg County Society 189 873

Mitchell County Society 875

Moore-Lee County Society 189 875

Montgomery County Society 189 876

McDowell County Society _ 876

Miliary Tuberculosis, Acute, The Diagnosis of. Dr. Silvio VonRuck, 406
61

962 INDEX.

PAGE.

Middle Ear Disease, Mastoid Complications of. Dr. J. M. Lilly. . . . 594

Minor Surgery, Some Points in 546

Mitchell, Dr. W. F 19

Mississippi Valley Medical Association, Delegates to 165

Moncure, Dr. Wm 24, 182, 720

Moncure, Dr. Wm. : "Coxa Vara" 720

Monk, Dr. H. L 20, 27, 36, 87

Morphine and Kindred Drugs, Use and Abuse, Dr. D. A. Garrison. . 786

Moseley, Dr. C. W 20, 27, 37, 85, 165, 193

Moseley, Dr. C. W., Elected Orator for 1909 193

Moore, Dr. E. C 24, 69, 70, 84, 528

Moore, Dr. E. C. : "Hydrocele" 528

Moore, Dr. E. C, Elected Honorary Fellow 194

Monroe, Dr. John P 27, 84, 94, 189

Monroe, Dr. W. A 189

Monstrosity, Eeport of a Case of, Dr. J. W. Neal 632

Monstrosities in Practice, Dr. G. L. Sykes 634

Murphy, Dr. P. L 25, 76, 77, 220, 224, 227, 276

Murphy, Dr. P. L., In Memoriam, Dr. Geo. G. Thomas 76, 220

Murphy, Dr. P. L., Portrait 220

Murphy, Dr. P. L., In Memoriam, Dr. R. H. Lewis 25, 76, 224

Murphy, Dr. P. L., In Memoriam, Dr. G. M. Cooper 25, 76, 227

Murphy, Dr. P. L., In Memoriam, Dr. A. W. Knox 25, 76

Murphy, Dr. P. L., Society Orders Portrait Published in Transac-
tions 77

Myers, Dr. John Q 170, 171, 192

Myxoedema Simulating Bright's Disease, Avith Eemarks as to Value

of Hydrastis in Albuminuria, Dr. Richard N. Duffy 771

McAnally, Dr. W. J 22, 91, 546

McAnally, Dr. W. J.: "Some Points in Minor Surgery" 546

McBrayer, Dr. Lewis B 26, 28, 89, 93, 95, 120, 123, 127, 131,

134, 140, 171, 208, 295
McBrayer, Dr. Lewis B. : "The Importance of the Work of the Gen-
eral Practitioner" 295

•McBrayer, Dr. Lewis B., Elected Member of Board of Medical Ex-
aminers 89, 93

McBryde, Dr. M. H 186

McConnell, Dr. John W., Highest Mark on Examinations 205, 944

McCracken, Dr. J. R 20, 36, 710

McCracken, Dr. J. R.: "Pleurisy in Children" 710

McCampbell, Dr. John 28, 377

McCampbell, Dr. John: "Some Observations on Pellagra in This

Country, with Special Reference to Pellagrous Insanity" 377

McGougan, Dr. .1. Vance 170

McGee, Dr. J. W., Elected Honorary Fellow 194

McGuire. Dr. Stuart 22, 23, 24, 25, 69. 70. 71, 74, 491

INDEX. 963

PAGE.

McGuire, Dr. Stuart: "The Influence of the General Condition of

Patient on the Eesult of a Surgical Operation"' 491

McGehee, Dr. J. W 19, 36

McKay, Dr. J. F 23, 68

MeKenzie, Dr. W. W 19, 27, 36, 84, 85, 87, 92, 93, 95, 208, 680

McKenzie, Dr. W. W.: "Maternal Nursing" 686

MeKenzie, Dr. W. W., Elected Member State Board Medical Ex-
aminers 84, 85, 93, 95

McMillan, Dr. J. D., Obituary of 246

McLaughlin, Dr. J. E 188

Nalle, Dr. Brodie C 25, 537

Nalle, Dr. Brodie C. : "Appendicostomy in Amoebic Dysentery" 537

Nash County Society 877

Neal, Dr. J. W 88, 94, 632

Neal, Dr. J. W. : "A Monstrosity" 632

Necrology 218 to 250

Newell, Dr. L. B 170, 193

Newell, Dr. L. B., Appointed Leader of Debate 1909 Session 193

New Hanover County Society 189, 878

Neurosis, Ovarian, Treatment of, etc.. Dr. J. Allison Hodges 303

Nicholson, Dr. J. L 27, 83, 93, 95, 189, 191, 208

Nicholson, Dr. J. L., Elected Member State Board of Medical Ex-
aminers 27, 83, 93, 95

Nicholson, Dr. S. T 27, 85, 165, 191

Nissen Park, Entertainment of Society at 28, 29, 105, 106

Noble, Dr. R. J., Elected Honorary Fellow 194

Nominations, Committee on 191, 192

Normal Salt Solution, Dr. C. A. Woodard 743

Northampton County Society 189, 879

Obituary, Report of Committee on 218 to 250

Obstetric Work of the General Practitioner, Dr. A. B. Croom 353

Officers State Medical Society, 1849 to 1908 6, 7, 8

Officers State Medical Society, Session 1908 11

Officers State Medical Society, Session 1909, Elect 12

Onslow County Society 189, 880

Oration, The Annual : "The Physician and Education," Dr. Thos.

R. Little 278

Orator Elect for 1909 Session, Dr. C. W. Moseley 193

Ophthalmology as Related to the General Practitioner, Dr. G. S.

Tennent 356

Outdoor Life for the Prevention and Cure of Disease, Dr. Paul

Paquin . . 431

Orange County Society 879

964 INDEX.

PAGE.

Pamlico County Society 189, 880

Pasquotank-Camden-Dare County Society 189, 881

Pender County Society ' 189, 880

Person County Society 880

Perquimans County Society 881

Pitt County Society 881

Paddison, Dr. J. R 22, 50, 53, 556

Paddison, Dr. J. R. : "Ligation of the Femoral Artery — Results" . . . 556

Paquin, Dr. Paul 17, 431

Paquin, Dr. Paul: "Outdoor Life for the Prevention and Cure of

Disease" 431

Parrott, Dr. James M 22, 24, 30, 50, 51, 81, 91, 115, 116,

117, 183, 184, 185, 188, 194, 196, 603
Parrott, Dr. James M. : "An Interesting Case of Stone in the Blad-
der" 603

Parrott, Dr. James M., Examination on Anatomy 196

Payne, Dr. Robert L 23, 56, 61, 519

Payne, Dr. Robert L. : "Some Practical Points in the Management

of Inguinal Hernia" 519

Pemberton, Dr. W. D 165, 186

Pellagra, Its Etiology and Pathology, Dr. C. H. Lavinder 303

Pellagra, Dr. E. J. Wood 385

Pellagrous Insanity, Observations on. Dr. John McCampbell 377

Personal Privilege, Appeals from Rulings of President Way,

27, 81, 93, 94

Philips, Dr. J. J 18, 34, 164, 165, 170, 186, 60S

Philips, Dr. J. J.: "Influenzal Arthritis" 608

Physician, The and Education, the Annual Oration, Dr. C. S. Man-
gum 2/8

Picot, Dr. L. J., Elected Honorary Fellow 194

Placenta Prajvia, Dr. H. B. Hiatt 661

Pleurisy in Children, Dr. J. R. McCracken 710

Pneumonia, Necessity for Quarantine in. Dr. Chas. B. Wilkerson. ... 471

Pneumonia in Children, Dr. J. A. Turner 705

President's Annual Address, Dr. J. Howell Way 251

President's Address, Report of Committee on 177

Practice of Medicine, Lines of Progress in, Dr. Thos. R. Little 284

Pridgeon, Dr. Claude L 21, 47 to 49

Pridgeon, Dr. Claude L., Response to Address of Welcome to Society, 47
Pseudo-leucocythaemia Infantum, Drs. J. A. Turner and W. M. Jones, 717

Pool, Dr. C. M 19, 165, 192

Pool, Dr. C. M., Elected Vice-President 165, 192

Puerperal Eclampsia, Dr. E. F. Strickland 651

Puerperal Eclampsia, with Report of Cases, Dr. John A. Ferrell . . . 656

INDEX. 965

PAGE.
Quarantine, Necessity for in Pneumonia, Dr. Chas. B. Wilkerson. . . 471

Quickel, Dr. T. C 18, 33, 462

Quickel, Dr. T. C. : "The Treatment of Typhoid Fever" 462

Railway Surgery, Conservatism in. Dr. W. P. Whittington 531

Rankin, Dr. Watson S 20, 23, 27, 37, 61, 62, 63, 64, 102,

139, 165, 170, 348
Rankin, Dr. Watson S. : "The Relation of the Laboratory to the

General Practitioner" 348

Randolph County Society 190, 882

Reaves, Dr. W. P 18, 35, 584

Reaves, Dr. W. P. : "Aerostatic Deafness" 584

Reagan, Dr. J. A 17, 30, 33, 111, 467

Reagan, Dr. J. A.: "Milk and Milk-sickness" 467

Reagan, Dr. J. A., Resolution of Society Relative to 30, 111

Reciprocity Licenses Issued by Board of Examiners at Winston. . . . 207

Reciprocity in Medical Licensure, Dr. Alfred A. Kent 481

Relations of State Society to American Medical Association, 266 to 268

Reitzel, Dr. J. E 18, 35

Report of Secretary, Dr. David A. Stanton 178 to 182

Report of Treasurer, Dr. H. McKee Tucker 182

Reports of County Societies 185 to 191

Report of State Board of Health, Dr. R. H. Lewis, Secretary, 215 to 217

Report of Nominating Committee, Officers Elected 192, 193

Report of State Board of Examiners, Winston Session 196 to 207

Report on President's Address 177

Report of Obituary Committee 218 to 250

Results of Surgical and Medical Treatment of Ovarian Neuroses

Contrasted and Compared, Dr. J. Allison Hodges 363

Reynolds, Dr. J. Herbert, Obituary of 248

Richmond County Society 190, 883

Ringer, Dr. Paul 17, 32, 452

Ringer, Dr. Paul: "Early Tuberculosis and Malaria: Their Differ-
entiation" 452

Ring, Dr. J. W.. . 91

Roberson, Dr. Chas 19, 30, 692

Roberson, Dr. Chas.: "An Artificial Food Suitable for Young In-
fants" 092

Robeson County Society 883

Rowan County Society 190, 885

Rockingham County Society 190, 885

Rutherford County Society 190, 884

Rodman, Dr. John C 23, 27, 64, 67, 85, 87, 94, 95, 208, 487

Rodman, Dr. John C. : "Surgical Conscience" 487

Rodman, Dr. John C, Elected Member State Board of Medical Ex-
aminers 27, 85, 94

966

INDEX.

PAGE.

Eodman, Dr. John C, Elected President State Board Examiners. . . 208

Rose, Dr. A. S 26, 27, 78, 90

Royal, Dr. M. A 18, 35

Royster, Dr. Hubert A I70

Russell, Dr. Frank H 196, 197

Russell, Dr. Frank H., Examination on Materia Medica 197

Sampson County Society 887

Scotland County Society 190, 888

Stanly County Society 196, 888

Stokes County Society 190, 889

Surry County Society 190, 889

Swain County Society 1 90, 890

Sectarian Medical Legislation in North Carolina 265

Serum Therapy, Dr. J. C. Grady 735

S. C. State Medical Society, Delegates Elected to 165

Shamburger, Dr. J. B 189

Shore, Dr. T. W 191

Shore, Dr. C. A 214

Shuford, Dr. J. H 165

Scarlatiniform Eruptions, Dr. J. Stevens Bro\vn 698

Smith, Dr. J. B 91, 120

Smithwick, Dr. J, W. P 18, 456

Smithwick, Dr. J. W. P.: "Some Atypical Manifestations of Ma-
laria" 456

Smallpox in North Carolina, State Board of Health Data 212

Smith, Dr. Owen 19

Spencer, Dr. W. 0 21, 24, 165

Speight, Dr. R. H., Elected Honorary Fellow 194

Spicer, Dr. John D., Obituary 248

Stamey, Dr. E. L 17, 32

Stewart, Dr. H. D 19, 36, 624

Stewart, Dr. H. D.: "The Things That Kill Women in Child-bearing,

and How and Why" 624

Stevens, Dr. Sam 27, 30, 88, 90^ 120, 121, 122, 132

Stevens, Dr. M. L 32, 165, 444

Stevens, Dr. M. L. : "The Turn of the Tide of Tuberculosis Mor-
tality" 444

State Board of Health, Review of Its History, and Suggestions 273

State Board of Health, Report of Secretary and Annua^ Meeting. . . . 214

Sikes, Dr. G. T 23, 28, 144, 166, 196, 198

Sikes, Dr. G. T., Report State Board Examiners 23, 196

Sikes, Dr. G. T., Examination on Chemistry 198

Stanton, Dr. David A 27, 86, 111, 129, 166, 178, 182, 185, 193

Stanton, Dr. David A., Report Secretary Society 178 to 182

Stanton. Dr. David A., Presents Reports of Officers Elected 165

I^■DEX. 967

PAGE.

Stanton, Dr. David A., Elected Delegate to American Medical Asso-
ciation 165, 193

Stanton, Dr. David A., Remarks on Labors of Former Councilors. . 185

Stiles, Dr. Chas. W 28, 32, 9(>, 104, 212, 325

Stiles, Dr. Chas. W. : "The Medical Influence of the Negro in Con-
nection with Anemia in the White Race" 325

Stokes, Dr. J. E 23, 30, 80, 111, 315

Stokes, Dr. J. E. : "The Problem of the General Practitioner to

Gynecology" 315

Stokes, Dr. J. E., Presides Over the Society 23

Strickland, Dr. E. F 19. 30, 651

Strickland, Dr. E. F. : "Puerperal Eclampsia" 651

Strong, Dr. C. M 24

Stone in the Bladder, Interesting Case, Report of. Dr. J. M. Parrott, 603

Soil Pollution, etc.. Dr. Chas. W. Stiles 96, 325

Surgical Conscience, The, Dr. John C. Rodman 487

Surgical Operations, Influenced by Condition of Patient, etc.. Dr.

Stuart McGuire 491

Surgical Cases, Report of a Few Recent, Dr. Joseph Graham 511

Surgery, Some Points in INIinor, Dr. W. J. McAnalh^ 546

Surgery, Results of in Certain Ovarian Neuroses, Dr. J. Allison

Hodges 156, 363

Surgeon, The General Practitioner as a. Dr. Edmund Harrison.... 370
Surgeon, The, as Related to the General Practitioner, Dr. Thos. E.

W. Brown 374

Sykes, Dr. G. L 19, 25, 71, 77, 161, 634

Sykes, Dr. G. L. : "Some Obstetrical Monstrosities in Country Prac-
tice" 634

Synoposis of Minutes of Winston Session, General Meeting.. 21 to 38

Tayloe, Dr. David T., Regrets from 34

Tayloe, Dr. Joshua 22, 50, 89, 91

Taylor, Dr. Isaac M. . 28, 30, 90, 94, 103, 120, 121, 124, 127, 128,

130, 133, 135, 137, 138, 140, 141, 148, 151
Taylor, Dr. Isaac M., Elected President pro tern of Council, 30, 120, 121

Terrell, Dr. A. J., Scores Highest Mark on Examination 205, 946

The Physician and Education, the Annual Oration, Dr. Chas. S.

Mangum 278

Therapeutics and Art, Dr. W. H. Boone 757

Thonip.=on, Dr. Cyrus 18, 165

Thomas, Dr. Geo. G 20, 25, 27, 28, 37, 70, 80, 87, 93, 94,

105, 165, 220

Thomas, Dr. Geo. G., In ]Memoriam Dr. P. L. Murphy 25, 76, 220

Thomas, Dr. Geo. G., Presides over Conjoint Session 27, 96

Thomas, Dr. Pride J 105. 193

Thompson, Dr. C. D 1 88

968 INDEX.

PAGE.

Tennent, Dr. Gaillard S 31, 356

Tennent, Dr. Gaillard S.: "The Relation of the Ophthalmologist to

the General Practitioner" 35tJ

Toxic Changes from Prolonged Use of Acetanilid, Dr. H. H. Kapp. . 780

Transylvania County Society 191, 890

Tuberculosis, N. C. State Association for Prevention of 212, 213

Tuberculosis, Relation of Milk Supply to, Dr. Tait Butler 335

Tuberculosis, Acute Miliary, Diagnosis of, Dr. Silvio VonRuck 406

Tuberculin Therapy, Dr. H. B. Weaver 395

Tuberculosis, Essentials in Treatment, Dr. J. E. Brooks 403

Tuberculosis, Use and Abuse of Drugs in, Dr. W. M. Jones 425

Tuberculosis, Importance of Early Diagnosis, Dr. D. A. Dees 43G

Tuberculosis, Treated by Ichthyolated Emulsion, Dr. John Roy

Williams 439

Tuberculosis, Turn of Mortality Tide in. Dr. M. L. Stevens 444

Tuberculosis, Tuberculin Therapy in. Dr. C. S. Grayson 446

Tuberculosis and Malaria, Differentiation, Dr. Paul Ringer 452

Tucker, Dr. John H 18, 35, 165, 190, 191

Tucker, Dr. H. McKee 19, 30, 182

Tucker, Dr. H. McKee, Report of Treasurer 182

Turner, Dr. J. P 22, 27, 30, 51, 52, 83, 125, 187

Turner, Dr. J. P., Guilford County Society Resolutions. ... 30, 114, 115

Turner, Dr. J. A 20, 36, 150, 705

Turner, Dr. J. A. : "Pneumonia in Children" 705

Turner, Dr. J. A., and Dr. W. M. Jones: "Report of a Case of

Pseudo-leucocythsemia Infantum" 717

Turck, Dr. Fenton B 18

Tull, Dr. Henry, Elected Honorary Fellow 194

Typhoid Fever, The Treatment of, Dr. T. C. Quickel ' 462

Typhoid Cholecystitis, Operation, Recovery, Dr. Wm. A. Graham. . . 534

Union County Society 191, 890

Vance County Society 191, 891

Vaccine Therapy in Tuberculosis, Dr. H. B. Weaver 395

Vampil, Dr. Randolph, Obituary of 247

Venesection, Dr. W. M. Lyday 751

Virginia Medical Society, Delegates Elected to 165

VonRuck, Dr. Silvio 17, 28, 32, 97, 406

VonRuck, Dr. Silvio: "The Diagnosis of Acute Miliary Tubercu-
losis" 406

VonRuck, Dr. Silvio, Successfully Controverts Dr. Tait Butler 97

Washington-Tyrrell County Society 894

Watauga-Mitchell County Society 894

Wake County Society 191, 892

INDEX. 969

PAGE.

Warren County Society 894

Wakefield, Dr. W. H 165

Waterworks of Winston-Salem, Invited to Inspect Same 27

Walker, Dr. H. D 189, 191

Warliek, Dr. E. S 33

Washburn, Dr. R. C, Obituary of 247

Way, Dr. J. Howell Frontispiece

Way, Dr. J. Howell 21, 23, 27, 28, 29, 34, 50, 61, 79, 80, 81,

92, 93, 94, 95, 105, 107, 108, 114, 139,

149, 165, 166, 167, 168, 193
Way, Dr. J. Howell, the Presidents Annual Address: "Random
Notes on the History, Aims and Purposes of the Medical Society

of the State of Xorth Carolina" 21, 50, 251 to 277

Way, Dr. J. Howell, President's Rulings Sustained on Appeals,

27, 81, 93, 94

Way, Dr. J. Howell, Remarks on Retiring from the Chair 167, 168

Way, Dr. J. Howell, Moves to Adjourn 173

Way, Dr. J. Howell, and Dr. Chas. O'Hagan Laughinghouse, Reso-
lutions of Relative to Prescribing of Alcoholics as Beverages

by Physicians 166

Wayne County Society 191, 895

Weaver, Dr. H. B 22, 23, 25, 27, 30, 32, 34, 58, 73, 85, 112,

150, 161, 165, 169, 170, 171, 395
Weaver, Dr. H. B.: "Vaccine or Tuberculin Therapy in the Treat-
ment of Tuberculosis" 395

Welcome, Address of to Society, Hon. O. B. Eaton 40

Welcome, Address of, Response to. Dr. Claude L. Pridgeon 47

Whittaker, Dr. R. A 17, 33

Whittington, Dr. W. P 20, 23, 24, 28, 37, 38, 50, 53, 54, 55,

71, 76, 102, 166, 171, 172, 531

Whittington, Dr. W. P.: "Conservatism in Railway Surgery" 531

Whitehead, Dr. Wm. H., Elected Honorary Fellow of Society 194

Wilkes County Society 191, 896

Wilson County Society 191, 895

Wilkins, Dr. S. A 20, 30

Wilkerson, Dr. Chas. B 17, 32, 471

Wilkerson, Dr. Chas. B.: "The Necessity of Quarantine in Pneu-
monia" "^71

Williams, Dr. John A 19, 23, 36, 540

Williams, Dr. John A. : "Local Anesthetics in Surgery" 540

Williams, Dr. J. M 19. 36

Williams, Dr. J. M. : "History of a Case of Hydatidiform Mole" 645

Williams, Dr. John Hey 65, 66

Williams, Dr. John Roy.... 27, 81, 82, 90, 93, 101, 113, 123, 132,

134, 135, 144, 439

970 INDEX.

PAGE.

Williams, Dr. John Roy: "A Report of Cases Treated with Ichthyo-

lated Emulsion Compound" 439

Williams, Dr. John Roy, Personal Privilege 27, 81, 82, 93, 101

Wood, Dr. E. J 24, 28, 72, 87, 88, 94, 101, 170, 177, 189, 384

Wood, Dr. E. J. : "Pellagra" 384

Woodard, Dr. Chas. A 18, 35, 743

Woodard, Dr. Chas. A.: "Normal Salt Solution: Its Uses and INIeth-

ods of Administration" 743

Work of the General Practitioner, Importance of. Dr. L. B. ^Tc-

Brayer 295

Wright, Dr. J. B 18, 35

Wright, Dr. J. Thomas 18, 35, 792

Wright, Dr. J. Thomas: "A Brief Report of Some Cases Which
Have Yielded Surprisingly to Electricity, to X-ray Treatment,

Snow's Tubes, and Mechanical Vibration" 792

Yancey County Society 897

Yadkin County Society 896

Young, Dr. L. B 17

Young, Dr. Robert S 20, 33, 37

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